(PUT THE 1ST BAR CODE LABEL HERE)
PUT SECOND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE THIRD ON THE TRANSMITTAL FORM.
(PUT THE 1ST BAR CODE LABEL HERE)
PUT SECOND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE THIRD ON THE TRANSMITTAL FORM.
(PUT THE 1ST BAR CODE LABEL HERE)
PUT SECOND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE THIRD ON THE TRANSMITTAL FORM.
242 RECORD HAEMOGLOBIN LEVEL HERE AND IN ANAEMIA PAMPHLET
(PUT THE 1ST BAR CODE LABEL HERE)
PUT SECOND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE THIRD ON THE TRANSMITTAL FORM.
PUT THE 1ST BAR CODE LABEL HERE.
BARCODE
PUT THE 2ND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE 3RD ON THE TRANSMITTAL FORM.
INFORMED CONSENT FOR ADULT 18 YEARS OR MORE
As part of this survey, we are doing a study of HIV/AIDS among women aged 15-49 years and men aged 15-59 years. You may know that HIV is the virus that causes AIDS. AIDS is a serious illness, usually mortal. We are currently giving HIV tests to see how serious a problem AIDS is in Mali.
For the HIV test, we ask all the eligible women and men to give a couple drops of blood from a finger. To take this blood we use sterile instruments, new material which is not reusable. It has never been used before and will be thrown away after the test.
The blood will then be sent to a lab to be analyzed. No name will be linked to the result. Thus, we will not be able to tell you your test results. No one else will know that result of the blood test either. However, I will give a reference paper to go to a Centre de Dépistage Volontaire (voluntary testing center) to have a free test if you wish.
Do you have any questions? Now, do you agree to take this HIV test?
PROCEED TO COLUMN (67) AND CIRCLE THE APPROPRIATE CODE.
(PUT THE 1ST BAR CODE LABEL HERE)
PUT SECOND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE THIRD ON THE TRANSMITTAL FORM.
(PUT THE 1ST BAR CODE LABEL HERE)
PUT SECOND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE THIRD ON THE TRANSMITTAL FORM.
(PUT THE 1ST BAR CODE LABEL HERE)
PUT SECOND BAR CODE LABEL ON THE RESPONDENT'S FILTER PAPER AND THE THIRD ON THE TRANSMITTAL FORM.
256) ASK CONSENT FOR DBS COLLECTION FROM RESPONDENT.
As part of the survey we also are asking people all over the country to take an HIV test. HIV is the virus that causes AIDS. AIDS is a very serious illness. The HIV test is being done to see how big the AIDS problem is in Togo.
For the HIV test, we need a few (more) drops of blood from a finger. The equipment used to take the blood is clean and completely safe. It has never been used before and will be thrown away after each test. No names will be attached so we will not be able to tell you the test results. No one else will be able to know your test results either. If you want to know you HIV status, I can provide a list of [nearby] facilities offering counseling and testing for HIV. I will also give you a voucher for free services for you (and for your partner if you want) that you can use at any of these facilities.
Do you have any questions?
You can say yes, or you can say no to the test. It is up to you to decide.
Will you take in the HIV test?