1 2 3 4 5 6 7

SIMS Unique Code Complete PID No.

(e.g. GC/SAICTC/MH/DDC/ccc/yy/00000 Name of Client
Year Month District Name of ICTC
SDLIC27260000003 (For Example : (FirstName_MiddleName_LastName)
60) GCSAICTCMHTHN0001500000)

2019 4 Ratnagiri ICTC LANJA SA/ICTC/MH/RTG/008/19/01026 SUCHITA SURESH KAMBLE

Ratnagiri GHR 1 Santosh Shantaram Ghanekar
GC/SAICTC/MH/RTG/001/19/30792
2019 4
2019 4 Ratnagiri GHR 1 GC/SAICTC/MH/RTG/001/19/30830 Prakash Digambar Sagvekar
2019 4 Ratnagiri R.H. Rajapur GCSAICTCMHRTG0111900572 Prakash Surykant Mandavakar
** ** ** ** ** **
 8 9 10 11 12 13 14

Gender
Age 1- Male, Aadhaar Number Mobile Number
Current Address Current Address
Current Address
Details/ Complete Address with PIN Code
2- Female, (10 Digit) Village/City Name
pincode (6Digit)
3- TS/TG

45 2 475847352651 9403365750 A/P MAJAL BHUDHWADI 416701 MAJAL

38 1 A/P-Deud, Gavatil Wadi A/P-Deud, Gavatil Wadi

60 1 A/P-Ril, Sonar Wadi A/P-Ril, Sonar Wadi

35 1 8976143652 At/Po Mumabai Andheri Gaval
** ** ** ** **
 15 16 17 18 19 20

Permanant
Current Address Current
Current Address
Permanant Address Address Permanant Address
Taluka / Address Details/ Complete Address with
State PIN Code Village/City Name
Corporation District pincode (6Digit)

LANJA RATNGIRI MAHARASHTRA A/P MAJAL BHUDHAWADI 416707 MAJAL

ratnagiri Ratnagiri Maharashtra A/P-Deud, Gavatil Wadi A/P-Deud, Gavatil Wadi

ratnagiri Ratnagiri Maharashtra A/P-Ril, Sonar Wadi A/P-Ril, Sonar Wadi

Rajapur Ratnagiri Maharashtra At/Po goval Madhaliwadi Goval
** ** **
 21 22 23 24 25 26

Occupation of Client:
1.Agricultural labourer,
2.Non-agricultural labourer,
3.Domestic servant, Route of Transmission:
4.House wife, Heterosexual
Education
5. Skilled worker, (1.a-Commercial Partner,
1-Non 6.Semi skilled worker, 1.b- Casual/non-commercial, non-
Iiterate, 7.Petty business/Large business/ small regular partner,
Permanant shop/ self employed,
Permanant 2-Primary 1.c-Regular partner/spouse) ,
Address Permanant Address 8.Service (Govt./ Pvt.),
Address School, 2.Homosexual / Bisexual,
Taluka / State 9. Student,
District 3-Secondary 10.TruckDriver/ helper, 3-Through blood and blood
Corporation
school, 11. Local transport workers (auto,taxi products,
4-College and driver, handcraft pullers, rikshaw pullers 4-Through infected syringe and
above etc), needles,
12. Hotel staff, 5-Parent to child (for children),
13. Agricultural cultivator/landholder, 6- Not specified/unknown

14. Unemployed or retired,

15. Others

LANJA RATNAGIRI MAHARASHTRA 3 4 1.b

ratnagiri Ratnagiri Maharashtra 3 1 1.b

ratnagiri Ratnagiri Maharashtra 2 1 1.b

Rajapur Ratnagiri Maharashtra 2 3 1.b
** ** ** ** **
 27 28 29 30 31 32

Patients referred from:

1.a.FSW NGO
1.b-MSM/TG NGO,
1.c -IDU NGO, History of
1.d- Migrants NGO, Migration:
1.e -Truckers NGO,
2.Non TI NGOs,
(1-History of History of
3-OBG/MaternityHomes, Migration at High risk
4.RNTCP, If Client
least once in last exposure: Date of testing
5-Blood Bank, referred from If referral from TI Client UID No. (if
6-Government Health Facilities, 6 month outside (1-at Native (DD/MM/YYYY)
IPD NGO, (write Name of TI client is reffered from
7-ARTc, district , place(Source),
8- STI clinics, 1-Yes NGO with Typology) TI NGO)
2- History 2- at
9-CCC, 2-No
10-DIC/PLHIV Networks, of Migartion at Destination
11-Private Health Facilities, least once in last Place
12-Link Workers,
13-Uniform forces,
6 month Outside
14- FICTC Govt. (Fixed/ mob), State
15-PPP ICTC (Fixed/Mob),
16-(PHC/Subcenter/ANM),
17- Others (Self referred)

6 No 1 20/04/2019
6 1
12-Apr-2019

17 1 22-Apr-2019
7 1 nil 2 2 04/08/2019
** ** ** ** ** **
 33 34 35 36 37 38

Date of post test Date of pre ART

Current CD4
counseling Registration
Pre ART Reg. No. Baseline Count (in On ART Reg. No.
(DD/MM/YYYY) (DD/MM/YYYY)
(SN/DNN/CNN/MM/YY/0000) CD4 Count last 6 (SN/DNN/CNN/MM/YY/0000)
month)

20/04/2019 25/04/2019 MH/RTG/19/6059 27 27

23 23
15-Apr-2019 15-Apr-2019
MHRTG/19/6058
25-Apr-2019 25-Apr-2019 MHRTG/19/6060 253 253
04/08/2019 11/04/2019
** ** ** ** ** **
 39 40 41 42 43 44 45

Marital Status
Whether
1-Marid
referred to
Whether 2-Unmarid / Spouse Test Pre ART
RNTCP Spouse testing
TB Single If yes then Spouse Complete PID No. Result Registration
1- Yes, done
Diagnosed 3-Divorced (PW/GC)/SAICTC/MH/DDC/ccc/yy/00000 1- Positive of Spouse
1-Yes
1- 4-Seprated (For Example : 2- Negative done
2- No, 2-No, 3-
Yes, 2- 5- Widow (PW/GC)SAICTCMHTHN0001500000) 1 = yes, 2=
3- already Pvt Tested
No 6- Baby (<14 No
registered in
year),
RNTCP
7-Other

1 2 1 1 SA/ICTC/MH/RTG/008/19/01068 2
1 5

1 1 GC/SAICTC/MH/RTG/006/19/00813 2
1 2 1 1 GCSAICTCMHRTG0111900573 2 2
** ** ** ** ** ** **
 46 47 48 49 50

Result of
Syphilis Test

Syphilis Test 1- Reactive Treated for

If "Yes" then Pre-ART Number If Spouse testing "Not" is Done Syphilis
(SN/DNN/CNN/MM/YY/0000) done then reason 1- Yes 2-NON 1= Yes,
2- No Reactive 2= No

3-Result
Awaited

1 2
1 2 2

1 2 2
1 2
** ** ** ** **
 51 52 53 54 55

Remarks
If eligible & recived Social
1-HIV-II ,
Benefits scheme write which on of 2-Client Death,
the following: 3-Spouse death,
1- SGNY, 4-Client Migrated,
2-SGSY, 5-spouse Migrated,
3-BSY, 6-WrongAddress/Changed Address,
Spouse 4- ATY, 7-spouse tested in other State, If Death of Client
If "No" then reason for Not
Treated for 5-ICDS, 8- Spouse not willing for testing , Write date of
Syphilis Test Conducted or Not 6-RKS,
Syphilis 9-Spouse not wiling for ART, Death
Done 7-Nutrition Support Scheme, 10-Client not willling for ART,
1= Yes, (DD/MM/YYYY)
8-Bus fare consession, 11-Client notwillling for follow up,
2= No 9-Railway fare consession, 12-Client is in followup(contacted by
10-IGNWPS, telephone, Home visit done),
11-IGNDPS, 13-Jail,
12-IGNOAPS, 14-post test not done,
13-Mediclaim Scheme, 15-Other
14- Other

1
2

2
1 1 4
** ** ** ** **
 56 57 58

If Patient is
INREFERRAL Is Client
from other ICTC, found positive
District or State in
then type ICTC General Remarks
Name, District
OUTREACH (for ICTC & ART)
name , State Activities
name 1-Yes
Otherwise left
2-No
blank

No ###

###

###
###
** **
 Summery Sheet For General Clients Line List
Month Wise HIV Detection
Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb
0 0 0 0 0 0 0 0 0 0 0
Age Groupwise (Positive) Gender Educatio
≤14 15-24 25-34 35-49 ≥50 Not Specified Male Female TS/TG Non Literate Primary

0 0 0 0 0 0 0 0 0 0 0
Patient is reffered from Occupation of Client

Non-
Female Sex Migrants Truckers OBG/Materni Agricultural agricultural Domestic
MSM/TG, IDU NGO Non TI NGOs House wife
Workers NGO NGO NGO ty Homes labourer servant
labourer

0 0 0 0 0 0 0 2 0 1 1

Local
transport
workers
Government (auto,taxi
DIC/PLHIV TruckDriver/
RNTCP Blood Bank Health ARTC STI clinics CCC Student driver, Hotel staff
Networks helper
Facilities handcraft
pullers,
rikshaw
pullers etc)

0 0 0 0 0 0 0 0 0 0 0
History of Migration in last 6 month
Private FICTC Govt. PPP ICTC
Uniform (Fixed/mob (Fixed/Mobil PHC/Subcenter/ Others (Self
Health Link Worker forces ANM) referred) Total Outside District OutSide
Facilities ile) e) State

0 0 0 0 0 0 0 0 0 0

Route Of Transmission Counselling information

 1.b- 3-Through
1.a 1.c- Regular 2. 4-Through 5-Parent to 6- Not
Casual/non- partner/spo Homosexua blood and Post test No. of Post Test
-Commercial infected syringe child (for specified/unk Testing Date
regular blood done remaining
Partner use , l / Bisexual products and needles children) nown
partner
0 0 0 0 0 0 0 0 0 0 0
ICTC - ART Linkages

Total No of No. client

Clients Registered (Pre ART%) Pre ART Regn. % Not Done Target for CD4 Actual No.of CD4 Testing Current CD4
Dignosed HIV Pre ART Date and having Not done Testing done (with %) done
Positive Pre-ART No.

0 0 0 #DIV/0! 0 #DIV/0! 0 0 #DIV/0! 0

Spouse Testing & other Information Marital Status From All HIV Pos

Spouse Tested at
Eligible Total No of Private (Need to No.of
Spouse Pre No. of No.of No. of
Spouse for Spouse % Testing Positive Negative test at ICTC Unmarried/
ART Married Divorced Seprate
testing Tested again for Singale
confirmation)

0 0 #DIV/0! 0 0 0 0 0 0 0 0
Govt. Social Benefit Schemes
Nutrition Bus fare Railway fare
SGNY SGSY BSY ATY ICDS RKS Support IGNWPS IGNDPS
consession consession
Scheme
0 0 0 0 0 0 0 0 0 0 0
Remarks
Client
Wrong Spouse Spouse not Spouse not Client not
Spouse Client Spouse notwillling
HIV-II Client Death Address/Change tested in willing for wiling for willling for
death Migrated Migrated for follow
d Address other State testing ART ART up
0 0 0 0 0 0 0 0 0 0 0
Syphilis Testing
Syphilis
Total Positive Syphilis Testing Not
Detected Testing Done Done
st For Summary Select below options
Total Summary for Period 1-Apr-2017 to 31-Mar-2018
Mar
0 0
Education Status Select District Maharashtra
college &
Secondary Above Total
0 0 0
Occupation of Client
Petty
business/
Skilled Semi skilled small shop/ Service
worker worker (Govt./ Pvt.)
self
employed

0 0 0 0

Agricultura
l Unemploye
cultivator/l d or retired Others Total
andholder

0 0 0 4
History of High risk exposure

at Native place at Destination Place

0 0

g information HIV-TB Coinfection

 No. of Post Test Refered to TB Dignosed Already on
remaining RNTCP DOTs

0 0 0 0

CD4<=500 On ART Clients %

0 0 #DIV/0!
l Status From All HIV Pos.Clients

No.of No. Baby Others Total

Widow (<14)

0 0 0 0

IGNOAPS Mediclaim Total

Scheme
0 0 0

Client is in Post test not

followup Jail done Total

0 0 0 0
 General Client Linelist - Qualitative Analysis
Sr.No Particulars Total
Total No.of Positive Detected Upto the Current Month 0
Spouse Testing ICTC - ART LINKAGES

Total No.of Pre-ART Registration out of Positive 0

Gap in ICTC - ART ( Referal & Linkages ) 0
% of ART Registration #DIV/0!
No.of CD4 Testing Done ( Out of Pre-ART Reg.) 0
CD4 less than 500 ( Eligible for On ART) 0
Total No. of Clients - On ART 0
Gap in Eligible & On ART Clients 0
% of On ART Clients #DIV/0!
Spouse Eligible for Testing 0
Actual Spouse Tested 0
Spouse Postive (out of Tested) 0
Spouse Negative (Out of Tested) 0
No.of Spouse Reg.to ART 0
Concordent Rate (%) #DIV/0!
Discordent Rate (%) #DIV/0!
Total No. of Positive 0
Refered To RNTCP 0
HIV - TB

Already Registerd to RNTCP 0

% of Out referral to RNTCP ( Out of Positive) #DIV/0!
No. of HIV-TB Co-Infected Clients 0
% of Co - Infected Clients #DIV/0!
No. of Clients Death reported 0
Deat

repo
rted

No. of Spouse deaths reported 0

h
 Age Wise Distribution
1

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0
≤14
0 15-24
0 25-34
0 35-49
0 ≥50
0 Not Specified
0

1 Patient in Referra
0.9
0.8
0.7
0.6
0.5
0.4
0.3
0.2
0.1
0
0 0 0 0 0 0 0 0 0 0 0
O G, O O O Os es CP nk es TC
G /T NG G G G m T a i ti R
rs
N
SM U sN sN N Ho RN d
B
c il A
ke M ID a nt ker TI ty oo Fa
r r uc n i Bl S
o ig Tr No rn l th
x W M ate He
a
Se M t
al
e
BG/ en
Fem O r nm
ve
Go

Occupation of Clie
2.5

2
2
 Occupation of Clie
2.5

2
2

1.5

1 1
1

0.5

0
0 0 0 0 0

PRE-ART Status

No. client Registered and having

Pre-ART No.

Pre ART Regn. Not done

 Route Of Transmission

1.a -Commercia

1.b- Casual/no

1.c- Regular pa

2. Homosexual

3-Through bloo
products

4-Through infec
needles

5-Parent to chil

6- Not specified

Marital Status

No. of Married
No.of Unmarried/Singale
No.of Divorced
No. of Seprate
No.of Widow
No. Baby (<14)
Others
 GC Positivity and Lin
1

0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0 0% 0%0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
0 0 0 0 0 0 0 0r 0 0i 0 0 0 0 0r 0r 0r 0 0r
gar laati ba d ed ra na u ule ol ia oli on na u tu u ed a h
o v e a a p r d g l p La p nd b
n a Ak mra ga B nd l dh d ra Dh c hi on Hi n l ga Ja l ha ag a ur as
ad A ra
n
Bh
a
Bu an d G Ja
Ko
N N nd N
m
Au Ch Ga Na
Ah O

No. of HIV Positive

Syphilis Testing
1

0.9

0.8

0.7

0.6
0.9

0.8

0.7

0.6

0.5

0.4

0.3

0.2

0.1

0
Total Positive Detected Syphilis Testing Done Syphilis Testing Not Done
 Education Status

Non Literate
Primary
Secondary
college & Above

Not Specified
0

atient in Referral

0 0 0 0 0 0 0 0r 0 0) 0) 0) 0
an
k es TC ic
s C
rk
s es ke ce
s le le d)
i ti R n CC o i ti r r i i N M re
il A li tw il o fo ob ob /A er
Fa
c Ic Ne Fa
c
k W m /m /M ter ref
ST IV Li n i fo
r d d n el
f
l th LH l th Fi
xe i xe bc
e
(S
He
a P He
a Un .t ( (F u rs
t C/ e v TC /S e
n DI at Go IC HC O th
ri v C P P
P CT PP
FI

ccupation of Client
ccupation of Client

0 0 0 0 0 0 0 0 0

Gender wise Distribution

Male
tered and having Female
TS/TG
ot done
 Spouse Testing
1

1.a -Commercial Partner 0.9

1.b- Casual/non-regular partner 0.8

1.c- Regular partner/spouse , 0.7

0.6
2. Homosexual / Bisexual
0.5
3-Through blood and blood
products
0.4

4-Through infected syringe and 0.3

needles
0.2
5-Parent to child (for children)
0.1
6- Not specified/unknown
0
0
Total No of Spouse Tested 0
Positive Spouse0Pre ART

ART Linkasge
1
0.9
0.8
0.7
0.6
0.5
No. of Married 0.4
No.of Unmarried/Singale 0.3
No.of Divorced 0.2
No. of Seprate 0.1
No.of Widow 0
No. Baby (<14) 0 0 0
ve ate o.
Others i ti
s TD TN
Po AR -AR
V e
HI Pr Pr
e
d
se ng
no vi
ig ha
D d
ts an
li en re
d
of
C si te
No eg
l ntR
ta lie
To . c
No
 V eA -A
HI Pr P re
d g
se vi
n
no ha
Dig d
nt
s an
il e d
C tere
of gi
s
o Re
lN nt
ta lc i e
To .
No

ositivity and Linkages

100%

90%

80%

70%

60%

50%

40%

30%

20%

10%

% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0%
0 0 0 0r 0 0 0i 0 0 0 0 0 0 0r 0 0r 0 0 0l
tur ur ed a hik a d n ne a d i ri gli ra
urg u ne a h a i m a
p nd b a Pu g g n ta p a h d h tm
La g r s ab bh i a Sa Sa d
ol
a Th Pa l g ar as
Na Na ndu Na a n Pa r Ra atn dhu S W W Yava
R
Na Os
m
Si
n

o. of HIV Positive % ART Linkage

Pre ART
(empty)