Summary of Changes

Questionnaire Section	Modifications (with brief justification)	Currently Approved Instrument attachment(s)	Currently Approved Instrument* page#(question#)	Proposed Instrument attachment(s)	Proposed Instrument* page#(question#)	Burden (Increase, Decrease, No change)	Total Number of Questions	Change
Eligibility Screener (ES)	Question ES5 of the approved eligibility screener measures which county participants currently reside in. The question includes the following instruction: "(List of eligible counties on computer)". The proposed eligiblity screener includes a list of all counties that are listed on the computer for each city. This additional information adds length to the eligibilty screener document, but does NOT change the participant burden. The eligibile counties have NOT changed, the only change is that the proposed eligibly screener lists each county while the approved screener does not.	Eligibility Screener	p.4(ES5)	Eligibility Screener	p.13-24(ES5_ATL1-ES5_WDC)	No Change	0	0
Eligibility Screener (ES)	2 questions were dropped from the eligibility screener (ES) regarding length of residence in the participating project area. These questions have not been used in analysis or reports to date and were found to be confusing to participants who lived in the MSA for non-consecutive periods	Eligibility Screener	p.5(ES5a) p.5(ES5b)			Decrease	2	-2
Eligibility Screener (ES)	1 question that elicits information used in calculating sampling weights was moved from the sexual behavior section (SX) to the eligibility screener (ES) to provide important weighting data on all screened participants.			Eligibility Screener	p.26(ES9c)	Increase	1	1
Demographics (DM)	1 question measuring language spoken with family and friend was deleted, this information is now measured using 3 questions (see next row) required by Department of Health and Human Services (DHHS) data standards.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.10(DM-3b)			Decrease	1	-1
Demographics (DM)	3 questions were added to measure language spoken at home as required by DHHS standards			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.18(DM3b1) p.18(DM3b2) p.18(DM3b2spec)	Increase	3	3
Demographics (DM)	2 questions measuring disclosure of sexual preference to LGBT friends were found to have minimal variability in previous cycles (~99% YES responses) and consequently were determined not to yield beneficial data and deleted.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.16(DM-10b.1); p.45(SX-52a.1)			Decrease	2	-2
Social Experiences (SO)	A new "Social Experiences" (SO) section was created to house questions on disclosure of sexual identity, discrimination, perceived community tolerance, and internet use. The creation of this section improves interview flow and questionnaire organization, but does NOT impact participant burden. Modifications to questions in this section are detailed below	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.44(SX-51); p.45(SX-52); p.45(SX-52a1 to SX52a5); p.45(SX-53a to SX-53e); p.46(SX53f)	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.24(SO1); p.24-25(SO2a to SO2d); p.25-26(SO3a to SO3e); p.26(SO4); p.26(SO5)	No Change	12	0
Social Experiences (SO)	1 question measuring disclosure of sexual preference to 'spouse or female partner' was modified to 'female partners' to improve question clarity. For men who have sex with men (MSM), the term "spouse" may refer to males or females, the question's intent is to measure disclosure of sexual preference to female partners only.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.45(SX-52a.4)	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.25(SO2c)	No Change	1	0
Sexual Behavior (SX)	6 questions measuring whether participants had sex for the first time within the past 12 months with their recent partners were deleted; these data did not provide sufficiently useful information to warrant continued collection. Further, the questions proved cognitively difficult for participants to answer and for researchers to interpret.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.20(SX-6e); p.22(SX-7e); p.33(SX-31c); p.35(SX-32c); p.49(SX-59e); p.50(SX-60e)			Decrease	6	-6
Sexual Behavior (SX)	9 questions measuring exchange sex in the past 12 months were deleted. Deleted questions measured exchange sex among main partners and males selling sex to females. These questions are no longer a priority for data collection.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.20(SX-6f); p.20(SX-6g); p.22(SX-7g); p.24(SX-11a); p.33(SX-31d); p.34(SX-31e); p.49(SX-59f); p.49(SX-59g); p.50(SX-60g)			Decrease	9	-9
Sexual Behavior (SX)	4 questions measuring certain types of exchange sex were modified to improve clarity and simplify language. Modified questions included males buying and selling sex to male casual partners and males buying sex from female casual partners.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.22(SX-7f); p.36(SX-32d); p.36(SX-32e); p.50(SX-60f)	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p36(SX7e); p.43(SX15c); p.43(SX15d); p.53(SX23e)	No Change	4	0
Sexual Behavior (SX)	14 questions measuring serosorting (having sex only with persons of the same HIV status as yourself) in the past 12 months were deleted because they proved cognitively difficult for participants to answer and yielded data of poor quality. New, improved questions were developed to fill this data need (see next row)	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.22(SX-8); p.22(SX-8a); p.23(SX-8b); p.33(SX-31b.1); p.33(SX-31b.2); p.33(SX-31b.3); p.43(SX-31b.4); p.35(SX-32b.1); p.35(SX-32b.2); p.35(SX-32b.3); p.35(SX-32b.4); p.51(SX-61); p.51(SX-61a); p.51(SX-61b);			Decrease	14	-14
Sexual Behavior (SX)	9 questions were added to measure serosorting (having sex only with persons of the same HIV status as yourself) in the past 12 months. These replace the 14 questions previously used for this measure (see previous row).			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.37(SX8); p.37(SX8a); p.37(SX8b); p.44(SX16); p.44(SX16a); p.44(SX16b); p.54(SX24); p.54(SX24a); p.54(SX24b)	Increase	9	9
Sexual Behavior (SX)	28 questions measuring behavior during last sex with a female partner among male participants and the characteristics of the last female sex partner were deleted. These data are now collected for the last sex partner only (male or female) as part of the new partner-by-partner series added to the sexual behavior section (described in rows 20-22 of this spreadsheet) Note: 3 parallel sets of last partner questions (male-female, male-male, & female-male) were deleted. Most NHBS participants only answered 1 of these sets. While 85 questions were deleted, the result is a net reduction of ~28 questions answered by each participant.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.23-30 (SX-9 to SX-25a)			Decrease	28	-28
Sexual Behavior (SX)	29 questions measuring behavior during last sex with a male partner among male participants and the characteristics of the last female sex partner were deleted. These data are now collected for the last sex partner only (male or female) as part of the new partner-by-partner series added to the sexual behavior section (described in rows 20-22 of this spreadsheet) Note: 3 parallel sets of last partner questions (male-female, male-male, & female-male) were deleted. Most NHBS participants only answered 1 of these sets. While 85 questions were deleted, the result is a net reduction of ~28 questions answered by each participant.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.37-44 (SX-33 to SX-49)			Decrease	29	-29
Sexual Behavior (SX)	28 questions measuring behavior during last sex with a male partner among female participants and the characteristics of the last female sex partner were deleted. These data are now collected for the last sex partner only (male or female) as part of the new partner-by-partner series added to the sexual behavior section (described in rows 20-22 of this spreadsheet) Note: 3 parallel sets of last partner questions (male-female, male-male, & female-male) were deleted. Most NHBS participants only answered 1 of these sets. While 85 questions were deleted, the result is a net reduction of ~28 questions answered by each participant.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.51-58 (SX-62 to SX79a)			Decrease	28	-28
Sexual Behavior (SX)	7 questions measuring type of contraception used were added. Measurement of contraception types allows monitoring of interaction between condom use and use of contraception not involving condoms.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.54(SX25a); p.54(SX25b); p.54(SX25c); p.55(SX25d); p.55(SX25e); p.55(SX25f); p.55(SX25g);	Increase	7	7
Sexual Behavior (SX)	1 question that elicits information used in calculating sampling weights was moved from the sexual behavior section (SX) to the eligibility screener (ES) to provide important weighting data on all screened participants.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.44(SX-50)			Decrease	1	-1
Sexual Behavior (SX)	4 questions measuring number of sex partners in the past 3 months were added as a lead-in for the new partner-by-partner series added to the sexual behavior section (described in rows 20-22 of this spreadsheet).			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.57(SX27a); p.57(SX27b); p.57(SX27c); p.58(SX27d);	Increase	4	4
Sexual Behavior (SX)	Series on last partner. This is the first set of the new partner-by-partner series added to the sexual behavior section. This section includes questions on: the partner's demographics, HIV status, & risk behavior; information about the relationship including its length, characteristics, & concurrency; and sexual behavior in the past 3 months including data on last sex act & the frequency of sex acts of various types the participant had with this partner. This series provides a more efficient means of collecting data previously collected in the "last sex with male partner" and "last sex with female partner" series (see rows 14-16 of this spreadsheet).			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.59(SX28); p.60-70(SX31-SX50b)	Increase	41	41
Sexual Behavior (SX)	Series on 2nd to last partner. This is the second set of the new partner-by-partner series added to the sexual behavior section. This section includes data on: the partner's demographics & HIV status and sexual behavior in the past 3 months including data on last sex act, the frequency of sex acts of various types the participant had with this partner. Only those participants who report at least 2 sex partners in the past 3 months will be asked this series. Based on previous data cycles, approximately 50% of participants will be asked this series.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.59(SX29); p.70-76(SX51-SX61b)	Increase	22	22
Sexual Behavior (SX)	Series on 3rd to last partner. This is the third set of the new partner-by-partner series added to the sexual behavior section. This section includes data on: the partner's demographics & HIV status and sexual behavior in the past 3 months including data on last sex act, the frequency of sex acts of various types the participant had with this partner. Only those participants who report at least 3 sex partners in the past 3 month will be asked this series. Based on previous data cycles, approximately 20% of participants will be asked this series.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.59(SX30); p.76-81(SX62-SX72b)	Increase	22	22
Alcohol Use (AL)	This section was modified to ensure comparability to questions asked as part of the Behavioral Risk Factor Surveillance System (BRFSS), 5 questions previously used by BRFSS were replaced by 4 questions currently used by BRFSS. BRFSS' alcohol focus has shifted away from heavy drinking and toward binge drinking.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.59-60 (AL-1 to AL-5)	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.83-84(AL1-AL3)	Decrease	1	-1
Injection Drug Use (ID)	8 questions were added to fill information gaps identified for this section: questions measuring distributive sharing (i.e., giving a used needle/syringe to another IDU as it relates to HIV transmission; types of needles/syringes used to better determine acquisition risk; and demographic questions about last sharing partner. New skip patterns were created to shorten the series and reduce redundancy.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.90(ID5a); p.90(ID5b); p.90(ID6g); p.92(ID7); p.92(ID7sepc); p.93(ID10); p.97(ID19); p.98(ID25)	Increase	8	8
Injection Drug Use (ID)	4 questions were added to the instrument for the data collection cycles focused on MSM and heterosexuals at high risk (HET) to replace 9 drug-specific questions asked of all injection drug users (IDU) in the IDU data collection cycle			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.89(ID4a); p.89(ID4b); p.89(ID4c.1); p.90(ID4c.2)	Increase	4	4
Injection Drug Use (ID)	3 questions measuring sharing of specific injection equipment (cookers, cotton, water) were deleted. In previous cycles, data from these questions have been combined into a single variable during analysis. Therefore, these questions were replaced by a single cumulative question (ID11, see next row).	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.65(ID-10); p.65(ID-11); p.66(ID-12)			Decrease	3	-3
Injection Drug Use (ID)	25 questions were modified to reduce recall bias and improve participants' ability to answer these questions; these included: modifying the response options for frequency of injection and drugs used, to ease cognitive burden and improve understanding; updating slang terminology for specific drugs to reflect current and usage trends; and improving questions measuring sharing and sharing partners to ease cognitive burden and improve understanding by participants.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.85-99(ID1-ID29)	No Change	25	0
Non-injection Drug Use (ND)	7 questions measuring use of drugs that have not been linked to HIV risk behavior or that had low prevalence in the previous cycles were deleted (LSD, GHB, Ketamine, other specify). A 3 question set on use of erectile dysfunction drugs with methamphetamine was simplified to 1 question.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.71(ND-2g); p.71(ND-2k); p.71(ND-2l); p.72(ND-2m1); p.72(ND-2m2); p.72(ND-3); p.72(ND-3a); p.72(ND-3b);	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.104(ND3)	Decrease	7	-7
Non-injection Drug Use (ND)	9 questions were modified to reduce recall bias and improve participants' ability to answer these questions. Question modifications included: modifying the wording of the drugs listed in the drug of choice and drug frequency questions to signal to the participant that the questions pertain to non-injection drug; modifying the response options for frequency of drug use, to ease cognitive burden and improve understanding; updating slang terminology for types of drugs to reflect current and usage trends			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.101-104(ND1-ND3)	No Change	9	0
HIV Testing Experiences (HT)	The HIV testing section was restructured to improve flow and clarity and to avoid confusion among HIV-positive participants.		p75-89(HT-1 to HT-17)	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p106-120(HT1-HT14)	No Change	31	0
HIV Testing Experiences (HT)	4 questions were deleted due to lack of use in previous cycles or low need for tracking over time: (date of first HIV test, open ended location of last HIV test, type of last test, rapid vs. non-rapid). An additional 4 out-of-date questions related to pre-exposure prophylaxis (PrEP) awareness and non-medical reception were deleted.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.75(HT-2); p.77(HT-4a); p.77(HT-4b); p.86(HT-8b); p.86(HT-8c); p.87(HT-12); p.89(HT-12d.1); p.89(HT-13)			Decrease	8	-8
HIV Testing Experiences (HT)	3 questions were added to fill data gaps identified during review: received result of recent test, home testing, location of first positive test.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.108(HT4b); p.109(HT5); p.111(HT7a)	Increase	3	3
HIV Testing Experiences (HT)	4 questions were added measuring negative test results before first HIV positive test, viral load testing, and viral load results.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.111(HT7e); p.118(HT10); p.118(HT10a); p.119(HT10b)	Increase	4	4
Health Conditions (HC)	2 questions were added measuring location of last hepatitis C test and anal/rectal sexually transmitted disease (STD) test in the past 12 months			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.122(HC2b); p.123(HC7)	Increase	2	2
Health Conditions (HC)	A 6 question scale was added to assess severe psychological distress. Psychological distress is associated with important HIV-related behaviors and outcomes, including risk behavior, testing & prevention behavior, utilization of HIV care, and adherence to treatment.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.125-126(HC10a-HC10f)	Increase	6	6
Health Conditions (HC)	6 questions were added measuring disability as required by DHHS data standards			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.126-127(HC11a-HC11f)	Increase	6	6
Health Conditions (HC)	20 questions were deleted because answered proved difficult for participants to recall. These questions were related to the vaccination, testing, diagnoses and treatment of Hepatitis A, B, and C; this series was streamlined to focus on Hepatitis C (e.g., diagnoses, treatment, and location of last test). Likewise, due to poor participant recall questions related to testing, diagnoses and treatment of other STDs, were streamlined to focus on testing for any STD versus specific STDs in the past 12 months and treatment of specific STDs.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.90(HC-1); p.90-91 (HC-2a to HC-4c); p.92(HC-5b); p.92(HC-5c); p.92(HC-6); p.93(HC-9); p.93-94 (HC-11 to HC-15);			Decrease	20	-20
HIV Testing in Jail (JT)	This section was streamlined to focus on whether participants were ever incarcerated, incarcerated in the past 12 months, and tested for HIV in jail in the past 12 months. All questions related to Hepatitis testing were deleted due to poor data quality.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.95-96 (JT-2a to JT-3b);			Decrease	5	-5
Assessment of Prevention Activities (PA)	11 questions collecting redundant data, data with limited prior use, or data on out-of-date prevention activities were removed. The change is expected to reduce the burden, improve efficiency of questions, and focus content on current prevention processes.	Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.97(PA-1b); p.98(PA-1c); p.98(PA-1d); p.101-103 (PA-4b to PA-5d);			Decrease	11	-11
Assessment of Prevention Activities (PA)	3 questions were added and 3 modified to address changing data needs related to PrEP due to recent FDA approval and subsequent CDC recommendation that PrEP be used as a prevention strategy among high risk persons.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.134(PA5a); P.134(PA5b); p.134(PA5d)	Increase	3	3
Assessment of Prevention Activities (PA)	1 question was added measuring perceived risk of acquiring HIV and 4 questions were added measuring intimate partner violence. Low perceived risk of HIV and/or intimate partner violence are both known barriers to condom use and other HIV prevention strategies.			Behavioral Assessment_MSM Behavioral Assessment_IDU Behavioral Assessment_HET	p.134(PA6); p.135(PA7-PA10)	Increase	5	5
Total Change									-25
*Page numbers correspond to English instruments. Page numbers in the Spanish instrument may be off by ±1 page due to differences in length of text between English and Spanish.