TRACE INITIATIVE: Risk Factor Questionnaire

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BACKGROUND

Effective Epidemic Control Requires Early Detection and Quick Response Interrupt further transmission Target prevention Analyze data in real time (who/where/why) Detect Recent Infections Rapid Test for Recent Infection

Demographics and Risk Factors Basic demographics help us understand where and amongst whom new infections are occurring Risk factors help us identify how to target prevention programs and response

Context/Purpose of the Risk Factor Questionnaire Why do we want to know about risk factors? We want to know if there are characteristics of clients that increase or reduce their risk for recent HIV infection. E.g. age, education, income, testing history, sexual practice, alcohol and drug use This information can be used by the MOH to develop targeted prevention programs for people at greatest risk for recent HIV infection. We encourage collecting as much information as possible in the context of routine care.

PROCEDURES

Example of Recency Testing Procedures STEP 1: Screen clients for eligibility STEP 2: Conduct Informed consent among eligible clients, enroll clients who consent STEP 3: Complete Participant Risk-Factor Questionnaire STEP 4: Collect Blood Specimens INSERT IMAGE HERE STEP 5: Package and Store Specimens for Transport to Lab STEP 6: Send specimens to the Lab LABORATORY Specimens processed, HIV recency tests performed, result returned to Health Facility STEP 7: Return HIV recency results to client and perform post-test counselling Before Recency Procedures Routine HIV Testing ? ..! Insert this slide if Recency testing will be conducted at a hub lab or central lab

Example of Recency Testing Procedures Before Recency Procedures Routine HIV Testing STEP 1: Screen clients for eligibility STEP 2: Conduct Informed consent among eligible clients, enroll clients who consent STEP 3: Complete Participant Risk-Factor Questionnaire STEP 4: Collect Blood Specimens ? ..! STEP 5: HIV recency tests performed STEP 6: Package and Store Specimens for Transport to Lab STEP 7: Send specimens to the Lab LABORATORY Specimens processed, VL test conducted, result returned to Health Facility STEP 8: Return HIV recency results to client and perform post-test counselling Insert this slide if Recency testing will be conducted at the health facility

Participant Risk Factor Questionnaire – Procedure Affix a Participant ID label in the appropriate place. Save the remaining copies of the Participant ID label to be used in the next step of the testing procedures Include interview information, such as: Name of the facility Facility code Interviewer name Client ID number (HTS, ART or ANC number) Date of the interview

Risk Factor Data Collection Systems If you are using a paper-based form, ensure a clear SOP on storage of forms in a locked cabinet until they are collected for data entry If data entry will occur at the laboratory, paper forms should be transported in a sealed envelope If you are using an electronic form, ensure a clear SOP for storage and charging of electronic devices Data entry should be done into a password protected database and should be linked to final RITA results Data should be reviewed for quality and used routinely

Participant Risk Factor Questionnaire – Procedure Find a quiet and private space in the health facility and start the interview. The Questionnaire may have several sections: Demographic characteristics: questions about marital status, education and employment HIV testing history: questions about most recent time and frequency of previous HIV testing, awareness of partners’ HIV status Sexual activity and history of sexually transmitted infections: questions about number of sex partners during the past 12 months, age of recent partners, concurrency of partnerships, condom use, partner circumcision status and recent diagnosis or symptoms of STI. Alcohol and drug use: questions about alcohol and drug abuse Abuse: questions about participant’s experience with physical and sexual abuse

Participant Risk Factor Questionnaire – Procedure Mark the participant’s responses on the questionnaire, following instructions on the questionnaire Sign or initial the bottom of the questionnaire when you finish the interview File the questionnaire in the appropriate place in the facility

PRO TIPS

Conducting the Interview Read all questions exactly as they are written on the Questionnaire If the participant doesn’t understand, you can clarify in a way that will help him or her to understand what is being asked “Probe” if the client’s response is unclear, or if you don’t think he or she understood the question Don’t “lead” the the participant to a response Do not appear judgmental or disapproving/approving of any responses

Building Rapport Be friendly: Be attentive: Be sincere and respectful Smile, but not too much (be friendly in a professional way) Be attentive: Listen and nod Be sincere and respectful Watch your body language: Face your body toward the client and try to have a relaxed body posture Read the questions in a friendly, natural manner Strive to be non-judgmental There are no right or wrong answers ? ..!

Probing for More Information Probes may be needed when: A participant seems to understand a question but gives an inappropriate response Does not understand what was asked Misinterprets the question Gives a response of “I don’t know” Avoids answering the question How to Probe: Repeat the question Pause, repeat the participant’s response back to them Use body language such as nodding or tilting your head as if to ask a question

KEY CONSIDERATIONS

How will information from the risk factor questionnaire be used? Immediate public health response Triage index clients’ contacts for HIV testing Enhance case management for linkage to treatment Conduct cluster analysis to inform targeting of prevention efforts

Example of use of data from risk factor questionnaire Factors associated with recent infection

Example of use of data from risk factor questionnaire Incidence estimation

Questions? Comments?

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