N°

Questions

Responses

JUMP

Q11

How tall is the patient?

/_________/ m

Q12

What is the patient’s weight?

/_______/Kg

Q13

In what year was your HIV infection discovered?

/___________/

Q14

Have you suffered from TB in the past?

1. YES

2. NO

If YES → Q15a

Q15a

Have you been declared cured after treatment?

1. YES

2. NO

Q15b

Did you give up treatment?

1. YES

2. NO

Q15C

1. YES

2 .NO

Q16

Do you live with a tuberculosis patient or have you lived with one in the past?

1. YES

2. NO

Q17

Have you ever been in prison?

1. YES

2. NO

Q18

Do you suffer from any co-morbidities or in the past?

1. diabetes

2. Bronchopneumopathy obstructives

3. COVID

4. hypertensive heart disease

5. others to be specified

Q19

Have you drunk in the past?

1. YES

2. NO

Q20

Have you smoked in the past?

1. YES

2. NO

Q21

What is the patient’s clinical stage?

1. Stage.1

2. Stage. 2

3. Stage. 3

4. Stage. 4