Case Report Forms

TRAX study staff form for interviewing participants on; sociodemographic information, substance use, alcohol use, smoking history, TB symptoms in the past six months, past medical history, HIV diagnosis, HIV testing and specimen collection.

TRAX: Patient Locator CRF (1225)

TRAX Case Report Forms TRAX TB/Coinfection Studies Contact Testing Community Resource Social Employment Rural Drug Intervention Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Occupation Address Relative Supervisor International 2014 Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

Participant’s current address with emergency contact, employment and treatment supervisor for TRAX.

TRAX: Chart Abstraction CRF (1224)

TRAX Case Report Forms TRAX TB/Coinfection Studies Contact Testing Community Location Resource Social Rural Drug Residence Intervention Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Town Employer Address School International 2014 TRAX-Document Methods Chart Extraction Clinical Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

TRAX staff medical records form including; admissions, hospital name, chest x-ray results, HIV diagnosis and results, TB hospital admission history, TB drug resistance history and current status, diabetes, TB history, medication history prior to diagnostic collection, viral load and CD4 count.

TRAX: Alternate CD4 Viral Load Lab Results CRF (1223)

TRAX Case Report Forms TRAX TB/Coinfection Studies Contact Laboratory Testing Community Resource Collection Social Rural Drug Intervention Viral Transmission Network Load Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Result CD4 International 2014 TRAX-Document Methods Clinical Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

TRAX participant lab results including: CD4 count and viral load.

TRAX: Screening CRF (1222)

TRAX Case Report Forms TRAX TB/Coinfection Studies Consent Screening Contact Participant Testing Community Resource Criteria Social Rural Drug Residence Intervention Inclusion Exclusion Lab Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Patient Age English International 2014 Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

Participant initial TRAX screening form including; exclusion and inclusion criteria.

TRAX: Home Visit CRF (1221)

TRAX Case Report Forms TRAX TB/Coinfection Studies Contact Testing Visit Community Resource Social Rural Drug Residence Intervention Primary Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Home Material Windows Building Rooms International 2014 Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

TRAX participant primary residence home visit form.

TRAX: Diagnostic TB Culture DST Results CRF (1220)

TRAX Case Report Forms TRAX TB/Coinfection Studies Contact Testing Community Resource Collection Results Social Rural Drug Intervention Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Patient Sputum Susceptibility Smear Culture Diagnostic DST International 2014 TRAX-Document Methods Clinical Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

Participant TB culture and DST results including: sputum collection, smear results, culture results, drug susceptibility testing (DST) results, interpretation for TRAX records.

TRAX: Hospital Key CRF (1219)

TRAX Case Report Forms TRAX TB/Coinfection Studies Contact Testing Community Resource Social Rural Drug Intervention Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Key International 2014 Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

Hospital key for TRAX.

TRAX: Baseline Auramine Results CRF (1218)

TRAX Case Report Forms TRAX TB/Coinfection Studies Contact Testing Community Resource Collection Social Rural Drug Intervention Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Auramine Sputum Result Stain International 2014 TRAX-Document Methods Clinical Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

Participant stain results including: date of sputum collection and auramine stain results for TRAX.

TRAX: Study Activities Checklist CRF (1217)

TRAX Case Report Forms TRAX TB/Coinfection Studies Screening Checklist Contact Testing Community Resource Enrollment Social Rural Drug Intervention Number Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Patient Activity Log International 2014 Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

Participant activity tracking log for TRAX including; screening, enrollment via a patient visit, enrollment after the patient visit.

TRAX: Social Network Questionnaire Tables CRF (1216)

TRAX Case Report Forms TRAX TB/Coinfection Studies Contact Testing Community Location Resource Social Rural Drug Residence Intervention Table Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Work Occupation Town International 2014 Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

Participant’s location questionnaire table; places of residence, location and contacts at places of work, locations at hospitals, other congregate locations and contacts for TRAX.

TRAX: Specimen Transfer CRF (1215)

TRAX Case Report Forms TRAX TB/Coinfection Studies Contact Laboratory Testing Community Resource Social Rural Drug Intervention Specimen Courier Transmission Network Africa Cluster Tracing Resistant Genotype Tuberculosis Mortality Patterns Epidemiology Limited Co-infection South Hospitals Immunocompromised Congregate Interaction Settings Dispatch Transport Transfer Physician Nurse Driver Technician International 2014 TRAX-Document Methods Clinical Prevention Community Health Behavioral Health Equity Virology Genetics Clinical Cross Sectional Study Clinical Chart Extraction Qualitative

Specimen transfer form to be completed by dispatch, transport, and laboratory staff for TRAX.