ASSESSMENT OF PUBLIC FACILITIES FOR READINESS TO DELIVER ANTIRETROVIRAL
THERAPY
Hospital/ Clinic ____________________________________Date _________________________
General:
A written plan of how to deliver ART is made and understood by the Clinic team (one page
maximum, to be available on the day of assessment)
Patient Flow Described
Yes
No
Discussed
Service days Specified
Yes
No
Discussed
Days between Group counselling and Initiation
All hospital / clinic staff are briefed about the delivery of ARV therapy
Yes
No
HTC Service:
**There is a service for providing counselling and HIV testing, or if not conducted in the hospital or
clinic there is a mechanism of being able to refer clients and patients to /from a HTC service
Yes
No
Counsellors working in the clinic/ hospital are briefed in ARV therapy
Yes
No
Dedicated room for HTC available at the HTC site
Yes
No
National standard HTC register available at the HTC site
Yes
No
HIV test kits stock card available at the HTC site
Yes
No
Infection prevention measures observed at all times
Yes
No
HIV / ARV Clinic
Dedicated room available for HIV/ART services
Yes
No
Is the room well equipped? (Check for the following)
**Chairs
Yes
No
**Table
Yes
No
Exam. Couch
Yes
No