Forms – Recency Learning Hub

The generic forms below have been developed by the TRACE Initiative team to support the roll-out of recent HIV infection testing. They are intended to be downloaded, adapted, and utilized by stakeholders in various countries. For technical assistance in adapting the materials to suit specific context and needs, please visit Contact Us.

Participant Tally Sheet

Asante Data Capture Form – Site Level

Recent HIV Infection Surveillance Register

Laboratory Requisition Form

Specimen Tracking Log Health Facility

Specimen Tracking Log Lab

Understanding HIV and Recent Infection Information Sheet

Adverse Events Tracking Register

Example Participant Risk Questionnaire Interview Guide

Readiness Checklist for TOT and Panel Preparation

CQI Monitoring Checklist

CQI Monitoring Checklist (Short Version)

TOT Pre- and Post-Training Assessment

TOT Pre- and Post-Training Assessment Answer Key

TOT Trainee Results Form – Asante

QC and TOT Panel Prep Reference Results Form

RTRI Training and Panel Prep Supply List with Plasma

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16b. RTRI Training and Panel Prep Supply List with DTS

Download Plasma Supply List

Download DTS Supply List

RTRI QC Logbook

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17b. RTRI QC Logbook Job Aid

Download Job Aid

Proficiency Panel Prep Reference Results Form

RTRI Proficiency Testing Results Form (DTS)

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19b. RTRI Proficiency Testing Results Form (Plasma)

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19c. RTRI Proficiency Testing Results Form (RTRI only)

Download DTS Form

Download Plasma Form

Download RTRI Only Form

RTRI Pre-Implementation Checklist

Station Set-Up Checklist

Practical Examination – Direct Observation Checklist (Asante)

Certificate of Completion Template

Participant List