MDR-TB CAM template for Active TICs and wereda Fps in Q1&Q2

For wereda TB focals

1)Total number of bacteriological confirmed DR- TB cases Treated from your wereda since 2007

2) Total number of pt who is illegible for first line LPA

3) Total number of House hold Visited

4) Total Number of contacts identified

5)Total number of contacts screened for TB symptoms

6)Total number of people screened by CXR

7)Total number of presumptive TB cases identified

8) Total number of people Reported with CXR abnormalites

9) Total number of People who give sputum sample for Gene X-pert

10) Total number of bacteriological confirmed pulmonary TB cases

11) Total number of pulmonary negative TB cases identified

12) Total number of EPTB cases identified

13) Total number of Drug Resistance (RR) TB cases identifed

14) wereda Campaign performance as per campaign template

For Active TFCs

1)Patients clinical status,

2) Regimen , Months on treatment and drugs the patient taking

3) ADR you encountered and reported

4) # of HH and Close Contacts and # of contacts screened frequency of screening

5) methods of screening used and screen results

6) SL drugs stoke status And problems encountered due to SL drug stoke out