TB in Prison Prog Assess Tool_templatev2

7/25/2019 TB in Prison Prog Assess Tool_templatev2

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ASSESSMENT OF THE TB IN PRISON PROGRAMQUESTIONNAIRE

Note:This questionnaire was developed as a guide or tool for TB program coordinators andmanagers in gathering important and relevant baseline data in jails or prison that plans toimplement or establish TB in Prison Program. Once lled up, the tool will provide data and

information on the status of TB program implementation in jail/prison and wea!ness andgaps in the program and the facilit".

INFORMATION

Prison/#ail$ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

&ddress$ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

'espondent ( Position$ %%%%%%%%%%%%%%%%%%%%

%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

)ate accomplished$ %%%%%%%%%%%%%%%%%%%%%%%%%%%%

I. PRISON/JAIL PROFILE

*.* T"peofprison$ +ational% 'egional% Provincial%% ,it" % -un.%%

+ationalsupported%%% /01support %

I.2,apacit"$ O2cial inmatepop.$ %% &ctual inmatepop.$ %%

I.3-anpower complement$

I.3.1 3ealth$

)octor%%% +urse %% -edTech/-icroscopist%%%Others%%% Please

4pecif"%%%%%%%%%%%%%%%%%%%%%%%%%%%%

I.3.2 +onhealth$ ________________

5arden%% #ail 0uards%%% &dmin sta6%%%

Others%%% Please specif"%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

I.4&vailabilit" of the health facilit" and services$ (please check)

I.4.1 3as a general clinic$ 784 %%% +O %%%

I.4.1.1 9f +O, where do "ou refer sic! inmates:

I.4.1.1.1 ;or consultation$ +earest govt. healthfacilit" %%%

Private health facilit" %%%

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I.4.1.1.2 ;or laborator" wor!up$ +earest 0ovt. healthfacilit" %%

Private health facilit" %%%

I.4.2 9s transportation service provided to referral facilit"$784%%% +O %%%%

II. MANAGEMENT OF INMATES WITH TUBERCULOSIS

II.1 )o "ou follow the )OT4 protocol 784 %%% +O %%%

II.1.1 9f 784, when did the facilit" started implementing )OT4(month/year)%%%%%%%%

II.1.1.1 #ail sta6 were oriented on TB )OT4 program 784+O%%%

II.1.1.2 #ail team was trained on TB )OT4 program 784 %%+O%%%

II.1.2 9f +O, are "ou aware of the )OT4 protocol 784 %%+O%%%

II.2 )oes the jail/prison manages its own inmates suspected with TB784 %%+O%%%

II.2.1 9f +O, where do "ou refer TB4 inmates:

)OT4 facilit"$ '31%%% 3ospital%%% linic%%% Others,specif"%%%%%%%%%%%%%%

+on)OT4 facilit"$ 3ospital%%% linic%%% Others,specif"%%%%%%%%%%%%%

II.3 5ho are the treatment partners assigned to the TB patients:

II.3.1 3ealth sta6$ 784 % , pls. specif" who %%%%%%%%+O%%

II.3.2 #ail/Prison sta6


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%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

II.4.2 3ave there been periods of stoc!out of drugs: 7es$%%%%% +o.$ %%%%%%

III. STATUS OF SICKNESS AND DEATHS DUE TO TB INJAIL/PRISON

III.1 TB sic!ness among inmates (Interview medical/jail staf, checkany records) _____

7ear 9nmate Pop.

Total +o.of TBases

'eferred

+o.)iagnosed

w/susceptible

TB

+o.)iagnosed w/ )'

TB

+o.)iagnose

d w/-)' TB

+o.)iagnosed w/ ?)'

TB

+o. of TBcases

diagnosed39@ positive

III.2 TB sic!ness among jail/prison sta6


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N#. I$m %$s N#

9@.*.*

There is a signed -emorandum of 1nderstanding

& jail/prison )OT4 Team has been organied.

9@.*.A.

The jail/prison )OT4 team meets at least once amonth.

9@.*.C

&ll members of the jail/prison )OT4 Team havebeen oriented or trained on )OT4.

IV.2 M"n"&$m$n #' TB P"i$ns

N#. I$m %$s N#

9@.>.* On the average, results of sputum microscop" areavailable within ve wor!ing da"s.

9@.>.> On the average, all inmates diagnosed as sputumsmear positive are able to start treatment within>C hours. 9f no, how man" da"s: %%%%%%%%%%%%%%%%%

9@.>.A &ll newl" committed inmates .C The jail uses a screening chec!list.9@.>.D & cough surveillance record is used to identif"

inmates who are TB s"mptomatic.9@.>.E & trained TB 3ealth &ide is assigned to each cell

to identif" inmates who are TB s"mptomatic.9@.>.F &ll treatment partners are trained on )OT4.9@.>.G Before release, all inmates undergo the same

screening procedure described for newl"committed inmates.

9@.>.H & comprehensive plan for continuing treatment.*I 9nmates who are on treatment but scheduled forrelease are properl" endorsed to the receiving)OT4 facilit" for continuation of treatment usingthe +TP 'eferral ;orm.

IV.3 In'$(i#n C#n!#)

N#. I$m %$s N#

[email protected]. & temporar" holding area has been designated

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N#. I$m %$s N#

* for smear positive [email protected].>

9nmates who are in the holding area undergo)44- after > wee!s.

[email protected]

4mearpositive patients remain in the holdingarea until the inmate has converted to smearnegative.

[email protected]

4mearpositive patients who are in the holdingarea wear face mas!s.

[email protected]

TB s"mptomatics who have not been diagnosedas sputumpositive wear face mas!s.

[email protected]

& sputum collection area has been designated.

[email protected] The sputum collection area is in a wellventilatedarea


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N#. I$m %$s N#

[email protected].*

The jail/prison conducts health promotionactivities.

[email protected].>

Target of health promotion activities are$

[email protected].>.*

9nmates

[email protected].>.>

@isitors of inmates .A

#ail 4ta6

[email protected].>.C

Others

[email protected] Other health information topics included duringTB orientation of inmates were/[email protected].*

1nderstand the importance of correct wa"of collecting sputum for microscop" (other lab. tests

[email protected].>

9mportance of treatment using )OT andsignicance of sputum followups

[email protected]

4imple measures to reduce the ris! oftransmitting TB


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[email protected]

The jail/prison team plans and evaluates its TBprogram implementation at least once a "ear.

V. TB P!#&!"m P$!'#!m"n($ 01___2 01____

9ndicators>I%%%% >I%%%% urrent 7ear

+o. L +o. L +o. LPopulation


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9ndicators>I%%%% >I%%%% urrent 7ear

+o. L +o. L +o. L)'


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$%evised as o" &' arch '*+ y -

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Documents

TB in Prison Prog Assess Tool_templatev2