1. TRACE INITIATIVE: Risk Factor Questionnaire

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3. BACKGROUND

4. 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

5. 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

6. 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.

7. PROCEDURES

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. PRO TIPS

15. 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

16. 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 ?
..!

17. 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

18. KEY CONSIDERATIONS

19. 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

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

21. Example of use of data from risk factor questionnaire
Incidence estimation

22. Questions? Comments?

23. Thank You!