Key Stakeholder Interview

Form Approved

OMB No. 0920-XXXX

Exp. Date: XX/XX/XXXX

Community Context Matters Study

Attachment 7

Key Stakeholder Interview Survey

Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

Key Stakeholder Interview Survey

These first few questions are to understand some basic information about you

Demographics

Age

1. How old are you today? __ __ (years)

Race/Ethnicity

2. Do you consider yourself Hispanic or Latino(a):

 Yes

 No

3. Which race you consider yourself (choose one or more):

 American Indian or Alaska Native

 Asian

 Black or African American

 Native Hawaiian or other Pacific Islander

 White

Sex/Gender/ Sexual orientation

4. Do you consider yourself to be…?

 Male

 Female

 Transgender

5. Do you consider yourself to be:

 Heterosexual or "Straight"

 Homosexual, Gay, or Lesbian

 Bisexual

6. What was your sex at birth?

 Male

 Female

Organization and Role

Next we will ask a few questions about your job and the organization you work for.

7. What type of organization do you work for? (Choose one)

 City or County Health Department

 State Health Department

 College or university

 Clinic or Medical center

 Community organization focused primarily on HIV prevention

 Community organization not primarily focused on HIV prevention

 Other (specify) 7a. _______________________________________

8. What is your role in the organization? (Choose one)

 Director or other executive leadership

 Mid-level manager

 Front-line staff

 Other (specify) 8a. _______________________________________

9. What is your profession? (Choose one)

 Counselor

 Epidemiologist

 Clinician

 Peer Educator

 Other (specify) 9a. _______________________________________

10. How many years have you been in your current position? __ __

Now, we will ask a few questions about HIV preexposure prophylaxis, also called PrEP. PrEP means a person who does not have HIV infection takes a daily pill containing anti-HIV medicines for several months or years to keep from getting HIV.

Basic PrEP Knowledge

11. Before today, have you heard of preexposure prophylaxis (PrEP)?

 Yes

 No (skip to Q14)

12. If yes, where did you hear about PrEP (check all that apply)

 A friend

 A family member

 A work colleague

 A health care provider

 An HIV prevention counselor

 On a website

 At a community meeting

 From a journal article

 Other (specify) 12a. ____________________________________

13. From what you heard, how effective is PrEP in reducing the risk of getting HIV infection? (Choose one)

 It doesn’t reduce the risk at all

 It reduces the risk a little bit

 It reduces the risk by about half

 It reduces the risk a lot

 It reduces the risk completely

 Don’t know

14. Do you know anyone who is taking PrEP?  Yes  No

For the next set of questions, please tell us whether you agree or disagree with the statement.

PrEP Knowledge/Attitudes

15. PrEP should only be given to people who are unable to make their partners use condoms	 Agree	 Undecided	 Disagree
16. PrEP should be given to anyone who wants to take it for HIV prevention	 Agree	 Undecided	 Disagree
17. PrEP will make people less responsible	 Agree	 Undecided	 Disagree
18. I worry about the side effects of PrEP medications	 Agree	 Undecided	 Disagree
19. It is difficult to take a pill every day	 Agree	 Undecided	 Disagree
20. Taking PrEP is simple and straightforward	 Agree	 Undecided	 Disagree
21. It is safe to take HIV medicine you order online for PrEP without seeing a doctor	 Agree	 Undecided	 Disagree

PrEP Information and Experience

22. If you wanted to learn more about PrEP in general, who would you trust to give you good information?

 A friend

 A family member

 A work colleague

 A health care provider

 An HIV prevention counselor

 On a website

 At a community meeting

 From a journal article

 Other (specify) 22a. _________________________________________

These last questions are about how attitudes about delivering PrEP for people in the population you serve. Please read each statement and place an X in the column that most accurately reflects your opinion of the statement. It is important that you comment on each statement.

	Section 1 Overall,	Strongly Disagree	Disagree	Uncertain	Agree	Strongly Agree
23.	I find frequently changing priorities for HIV prevention difficult to manage in my work environment	1	2	3	4	5
24.	I prefer to support HIV prevention methods that I am confident will not change	1	2	3	4	5
25.	PrEP can improve HIV prevention outcomes	1	2	3	4	5
26.	The health of persons at high risk for HIV acquisition can be improved through the provision of PrEP	1	2	3	4	5
27.	Providing PrEP can enhance a team approach to HIV prevention	1	2	3	4	5
28.	I lose some of my professional autonomy because of PrEP	1	2	3	4	5
29.	I feel a lot of pressure to support PrEP	1	2	3	4	5
30	I am satisfied with currently available HIV prevention methods	1	2	3	4	5
31	I have a responsibility to learn how to use new HIV prevention methods in my work	1	2	3	4	5
32	I see myself as a champion/leader for PrEP in my organization	1	2	3	4	5
33	I find PrEP generally complex	1	2	3	4	5

	Section 2 Overall, I think my organization	Strongly Disagree	Disagree	Uncertain	Agree	Strongly Agree
34.	Is committed to making PrEP delivery successful	1	2	3	4	5
35	Has experienced too much change over the past year	1	2	3	4	5
36.	Is generally successful with implementing changes in HIV prevention	1	2	3	4	5
37.	Effectively communicates about changes in HIV prevention	1	2	3	4	5
38.	Effectively shared information with (other) healthcare organizations	1	2	3	4	5
39.	Shares descriptions of experiences related to the implementation of PrEP with other organizations	1	2	3	4	5
40.	Is committed to meeting the HIV prevention needs of the populations it serves	1	2	3	4	5
41.	Values the use of standardized guidance to shape HIV prevention practices	1	2	3	4	5
42.	Has adequate staff to provide technical support for PrEP-related services	1	2	3	4	5
43.	Has access to experts who understand PrEP	1	2	3	4	5
44.	Does not have adequate methods to monitor PrEP use and its outcomes	1	2	3	4	5

	Section 3 Overall, I think the populations my organization serves	Strongly Disagree	Disagree	Uncertain	Agree	Strongly Agree
45.	Is interested in PrEP	1	2	3	4	5
46.	Is concerned that PrEP has more risks than benefits	1	2	3	4	5
47.	Is not aware of PrEP	1	2	3	4	5
48.	Knows where to get information about PrEP	1	2	3	4	5
49.	Prefers using standard HIV prevention methods	1	2	3	4	5
50.	Is worried about where the funding will come from for PrEP services	1	2	3	4	5
51.	Doesn’t know where to go to get PrEP services	1	2	3	4	5

Thank you for completing this survey.