Rapid-Rapid Monthly Tracking Form – v5

Please indicate what initial rapid and second rapid are used at your site ==== / Initial Rapid:
Determine●
StatPak ○
Oraquick ○
UniGold ○
Insti ○
Architect ○ / 2nd Rapid:
Oraquick ○
Determine○
StatPak ○
UniGold ●
Insti ○ / Please explain second rapid refusal or when a second rapid was Not Done. If you confirm with a different test please describe
Site Number / Site Description / MONTH / (#) Number Screened / (#) Prelim Positive / (#) Second Rapid Performed / (#) Second Rapid REFUSED / (#) Second Rapid CONFIRMED / Discordant Results (#) / NOTES
6493 / NJCRI- Office / 12/2014 / 40 / 1 / 1 / 0 / 1 / 0 / 12/4/14 - 321628
6490 / DOH Mobile 1 / 12/2014 / 29 / 1 / 1 / 0 / 0 / 1 / 12/7/14 – 321674 (DISC)
6487 / CDC Mobile 2 / 12/2014 / 10 / 2 / 2 / 0 / 2 / 0 / 12/14/14 – 321687; 12/17/14 – 423542(R2R)
6489 / CDC Mobile 3 / 12/2014 / 14 / 1 / 0 / 1 / 0 / 0 / 12/15/14- 321694 (INIT)
SITE Number / IF R-2-R please indicate screening SITE Number / Date / Positive or Discordant Client CTS Number
DO NOT INCLUDENJDH / NEW POS / RE-ENGAGED / ALREADY IN-Care / CLIENT REFUSED APPOINTMENT / Appt.
Date / CHARITY CARE REFUSED
/ Appt.
Kept?
(Y or N) / Appt.
No Show / Bus Days to Lab Intake / COMMENTS
6493 / 12/4/2014 / 321628 / 1 / 0 / 0 / 0 / 12/5/2014 / 0 / Y / 0 / 1
6490 / 12/7/2014 / 321674(DISC) / 0 / 0 / 0 / 0 / 0 / - / 0 / 0 / Determine FP Ab – RNA negative at Quest 12/12/14
6487 / 6581 (Isiah House0 / 12/14/2014 / 321687 / 0 / 1 / 0 / 0 / 12/16/2014 / 0 / Y / 0 / 2

SECTION 1: CUMULATIVE DATA

Rapid Testing may be done on the same or multiple venues. Here we show testing divided up during the month of December at NJCRI by the office, and the 3 mobile vans. DHSTS assigns site numbers. Please contact them to assign new site numbers. The same venue, e.g. the NJCRI Office could have more than one site number if it was important to aggregate data distinctly.

We have attempted to think of existing AND potential orthogonal pairs that are used or may be used in the near future as part of the Rapid Testing Algorithm. We ask that you identify the combination being used in your program. If you are using Determine as your primary test AND Unigold as the second rapid, we ask that you darken the appropriate circles. In Word you can do this by left clicking your mouse, holding the left clicker down and moving across the circle. Unclick. Go up to dropdown menus, select INSERT Symbol and then finding the dark circle ● which is located under subset ‘GEOMETRIC SHAPES’. The empty circle ○ is also found under subset ‘GEOMETRIC SHAPES’.

So each row is then filled with:

The NUMBER SCREENED

The NUMBER that were PRELIMINARY POSITIVE

HOW MANY SECOND RAPIDS were performed

HOW MANY SECOND RAPIDS were refused

HOW MANY SECOND RAPIDS CONFIRMED the first rapid

HOW MANY DISCORDANT RESULTS occurred during the month.

Under NOTES we’d like you to indicate the date of the positive followed by a -, followed by the CTS number WITHOUT the NJDH designation.

SPECIAL add-ons: (DISC) – Discordant; (R2R) – Rapid-to-Rapid (confirmation was done at your site on a client who originated elsewhere; and (INIT) if a client was positive on the initial test and refused the second test or just bolted.

SITE Number / IF R-2-R please indicate screening SITE Number / Date / Positive or Discordant Client CTS Number
DO NOT INCLUDENJDH / NEW POS / RE-ENGAGED / ALREADY IN-Care / CLIENT REFUSED APPOINTMENT / Appt.
Date / CHARITY CARE REFUSED
/ Appt.
Kept?
(Y or N) / No Show / Bus Days to Lab Intake / COMMENTS
6487 / 12/17/2014 / 423542(R2R) / 1 / 0 / 0 / 0 / 12/20/14 / 0 / Y / 0 / 3 / Rapid-2-Rapid screened at Isiah House, transported to NJCRI for second rapid and linkage to care.
6489 / 12/15/14 / 321694 / 0 / 0 / 0 / Y / 0 / 0 / 0 / Client refused 2nd rapid and left mobile van. NAP notified to follow-up. Navigator outreach.
SUMMARY

INSTRUCTIONS: If your site provides Rapid-2-Rapid testing on behalf of another location, PLEASE enter theirSite Numberin the second column (gray section). Please use the first column to capture your Site Number where the second (Unigold) rapid is being performed. PLEASE check off your INITIAL and Second Screening tests (Determine, StatPak, Unigold, Insti or Architect).

DO NOT RETURN PAGE 2 IF THERE ARE NO ENTRIES

DO NOT INCLUDENJDH as part of the CTS number – it’s redundant.

INDIVIDUAL DATA:

This is the second page of the Monthly Tracking Form. It follows EVERY reactive that you identified on the cumulative page.

If the client was an R2R (came from another site) you place the site number they came from in the gray column. Your site number goes in the first column.

Special Considerations:

(DISC) is a discordant result. Assuming that it turns out to be a FALSE POSITIVE screening there should be a 0 in the next four columns, followed by a blank (no appointment made) and whatever follow-up details came out of the discordant process. In this case it was a Determine FP Antibody which was RNA negative at Quest on 12/14

As you can see each line details a specific client, by CTS number, by whether they are: ‘new’, ‘re-engaged’, ‘Already in Care’ or ‘REFUSED’ linkage. The date of the appointment is requested, whether they were denied care because they were a charity client; whether they kept the appointment, were an appointment ‘no show’ and how many BUSINESS DAYS it took for follow-up LABORATORY INTAKE (CD4, Viral Load).

The last row summarizes each of the columns.

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