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Form Approved OMB No. XXXXXXXX Exp Date XX/XX/20XX
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Clinician Context Matters
Thank you for agreeing to participate in this survey research to help CDC and [clinic name] understand the beliefs and
attitudes of clinicians about implementing HIV preexposure prophylaxis (PrEP) with patients in this clinic. We want
your perspectives on what helps or hinders the introduction of this clinical intervention in community health centers
serving populations with high rates of HIV infection.
The survey will take about 30 minutes. We will repeat the survey of clinicians in another 12 months and then again in
another 24 months from today. We are not offering you any money or gifts to take this survey.
The survey will not ask for your name or any other information that would identify you as an individual. You have been
assigned a studyspecific provider ID number that is used only to determine the proportion of eligible providers who
respond to the survey. All answers you give to survey questions will be confidential. They cannot be linked to you as a
person by CDC and will not be provided to anyone at the clinic by provider ID.
Taking this survey is completely voluntary. You are free to decide not to participate. If you decide to participate, you are
free to stop answering survey questions at any time for any reason. You can refuse to answer any individual question.
Because they are not linked to any identifying information, your individual responses to this survey cannot be disclosed
to, and will not affect, your employment,
Although this study will not benefit you personally directly, we hope that our results will help us improve HIV prevention
services at your and other community health centers.
If you have any questions about this study, you may contact [name, email, phone of site PI].
If you have any questions about your rights as a study participant, you may contact [name, email, phone of chair of the
local IRB].
If you feel you have been harmed in any way by participating in this interview, you may contact Dr. Dawn K. Smith at
404.639.5166 or [email protected].
*1. Please enter your confidential ID number
ID number
*2. Please enter the city in which your clinic is located
j Chicago
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j Houston
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j Newark
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j Philadelphia
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Clinician Context Matters
*3.
Do you agree to complete the survey?
j I agree to participate in the survey
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j I do not agree to participate in the survey this year.
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Thank you for taking time to answer these questions. The first questions are about your professional training and role in
this clinic.
4. Which best describes your profession/occupation? (Choose one)
j Physician
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j Nurse Practitioner
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j Registered Nurse
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j Physician's Assistant
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j Medical Assistant
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j Pharmacist
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j Other (please specify profession/occupation)
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n
5. Which best describes your professional training or specialization? (Choose one)
j General Adult Medicine
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j Pediatrics/Adolescent Health
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j Women’s Health/Obstetrics/Gynecology
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j Infectious Disease/STI
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j HIV Medicine
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j Other (please specify training/specialization)
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6. Year first licensed to practice in the US (if not licensed, enter 9999)
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Clinician Context Matters
The next set of questions will help us understand the demographic characteristics of clinicians responding to this
survey. Remember that your responses to these questions are not linked to any information that would identify you as
an individual. You can refuse to answer any individual questions. but answering these demographic questions will help
us understand the perspectives of clinicians.
7. How old are you today?
8. What was your sex at birth?
j Male
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j Female
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n
9. Do you consider yourself to be...?
j Heterosexual or "Straight"
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j Homosexual, Gay, or Lesbian
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j Bisexual
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j Other (please specify)
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10. Do you consider yourself Hispanic or Latino(a)?
j Yes
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j No
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n
11. Which race you consider yourself (choose any):
c White
d
e
f
g
c American Indian or Alaska Native
d
e
f
g
c Asian
d
e
f
g
c Black or African American
d
e
f
g
c Native Hawaiian or other Pacific Islander
d
e
f
g
12. In what country were you born?
j United States (including Puerto Rico, Guam, US Virgin Islands, or Northern Marianas)
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j Other country (please specify)
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Page 4
Clinician Context Matters
13. What year did you come to live in the United States?
Year
The next set of questions are about your clinical practices, knowledge, and attitudes related to HIV prevention and
treatment. Please give us your best estimate of numbers and percentages of patients in the questions that follow.
14. What percentage of the patients you provide direct clinical care do you estimate are:
(the totals do not need to equal 100%)
Adult women (18 years or older)
Adult heterosexual men (18 years or older)
Adult men who have sex with men (18 years or older)
Adolescents (1317 years)
Injecting drug users (currently injecting)
15. In an average month, for approximately how many HIVinfected patients do you
prescribe antiretrovirals or provide other clinical care?
Number HIV+ patients
16. For approximately what percentage do you know the HIV status of their current sexual
partner(s)?
Percent of HIV+ patients with known status of partner(s)
17. For approximately how many HIVuninfected patients have you ever prescribed 28
days of antiretrovirals for nonoccupational postexposure prophylaxis (nPEP)
Number patients ever prescribed nPEP
18. For approximately how many HIVuninfected patients have you ever
prescribed/provided antiretrovirals for PrEP
Number patients ever prescribed PrEP
Page 5
Clinician Context Matters
19. When doing an initial clinical care visit with a person not known to have HIV infection,
for which patients do you do the following: (Choose one response per row)
Any patients I feel Any patients that I
All new patients
Take a sexual activity
are at moderate
suspect are at
Only for patients
risk for getting HIV high risk for getting who bring it up
For no patients
infection
HIV infection
j
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history
Ask about sexual
orientation
Take a substance
abuse history
Ask about prior HIV
tests
Conduct an HIV test
(unless refused
Ask about HIV status
of sexual partner(s)
Page 6
Clinician Context Matters
20. How would you manage the following patients if their reported risk behaviors indicated
potential utility for PrEP?
(Choose one response per row)
Provide PrEP
Provide PrEP
with an
Adjust the dose Withold PrEP
with Truvada alternative drug
regimen
Patient has an
Discontinue
of Truvada for
until specific
PrEP with
PrEP
conditions met
Truvada
Not Sure/Don’t
Know
j
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n
j
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estimated creatinine
clearance <60 ml/min
before initiating PrEP
Patient has an
estimated creatinine
clearance <60 ml/min
8 months after
initiating PrEP
Patient reports a
negative HIV test 3
months ago at a
confidential testing
site
Patient has a negative
rapid test for HIV and
reports having a fever
and mile diarrhea for
several days 2 weeks
ago
Patient’s spouse is
HIVpositive but is not
on antiretroviral
therapy
Patient has hepatitis C
infection and is not
currently on treatment
Patient has chronic
active hepatitis B
infection and is not
currently on treatment
Patient is pregnant,
her husband is HIV
positive and has an
Page 7
Clinician Context Matters
undetectable viral load
Patient has been on
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PrEP for 6 months, is
reporting consistent
daily pill adherence
and less condom use
than when PrEP was
initiated
Patient has been on
PrEP for 6 months, is
reporting consistent
daily pill adherence,
but has filled only 2 of
5 monthly refills.
Patient is actively
injecting heroine and
doesn’t want to enter
treatment right now
Patient is actively
injecting
methamphetamines
and doesn’t want to
enter treatment right
now
We are interested in your views about changes in medical practice based on new evidence. Please rate your agreement
or disagreement with each statement on the following scale.
Page 8
Clinician Context Matters
21. Please rate your agreement or disagreement with each statement.
(One response per row)
Clinical experience is
Strongly Agree
Agree
Neutral
Disagree
Strongly Disagree
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more important than
randomized controlled
trials
I am comfortable
practicing in ways
different than other
doctors
Evidencebased
medicine makes a lot
of sense to me
I don’t have the time to
read up on every
practice decision
It is best to change
the way I treat a
certain problem when
my local colleagues
are making the same
changes
I follow practice
guidelines if they are
not much hassle
The opinions of
respected authorities
should guide clinical
practice
I am too busy taking
care of patients to
keep up with the
recent literature
Clinical experience is
the most reliable way
to know what really
works
I am uncomfortable
doing things differently
from the way I was
Page 9
Clinician Context Matters
trained
I am often critical of
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accepted practices
Patient care should be
based where possible
on randomized
controlled trials, rather
than the opinions of
respected authorities
My colleagues
consider me to be
someone who
marches to my own
drummer
I follow practice
guidelines as long as
they don’t interfere too
much with the flow of
patients
It is not prudent to
practice out of step
with other physicians
in my area
The best practice
guidelines are based
on the results of
randomized controlled
trials
Evidencebased
medicine is not very
practical in real patient
care
The next set of questions are about your assessment of changes in clinical practice related to implementing PrEP at
your clinic
Page 10
Clinician Context Matters
22. Please rate the strength of evidence for this statement:
Practice goals for providing PrEP will improve outcomes for patients with high risk for
acquiring HIV infection.
Based on your own
Very weak
Weak
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Neither weak
Strong
Very Strong
Don’t know/NA
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nor strong
assessment, the
evidence basis for this
statement is
Based on your
assessment of how
respected clinical
experts in your
institution feel about
the strength of the
evidence, this
statement is
Page 11
Clinician Context Matters
23. Please rate the strength of your agreement with the following statements:
(one response per row)
The proposed practice changes or guideline implementation for providing PrEP:
are(is) supported by
Neither agree
Agree
j
k
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n
j
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nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
RCTs or other
scientific evidence
should be effective,
based on current
scientific knowledge
are supported by
clinical experience
with patients in
community health
centers
conform to the
opinions of clinical
experts in practice
settings similar to ours
have been well
accepted by patients
in a pilot study
are consistent with
clinical practices that
have been accepted
by patients in
community health
centers
take into consideration
the needs and
preferences of
community health
center patients
appear to have more
advantages than
disadvantages for
community health
Page 12
Clinician Context Matters
center patients
24. Please rate the strength of your agreement with the following statements:
Senior leadership/clinical management in your organization
Reward clinical
Neither agree
Agree
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n
j
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nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
innovation and
creativity to improve
patient care
Solicit opinions of
clinical staff regarding
decisions about
patient care
Seek ways to improve
patient education and
increase patient
participation in
treatment
Page 13
Clinician Context Matters
25. Please rate the strength of your agreement with the following statements:
Staff members in your organization
Have a sense of
Neither agree
Agree
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n
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nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
personal responsibility
for improving patient
care and outcomes
Cooperate to maintain
and improve
effectiveness of patient
care
Are willing to innovate
and /or experiment to
improve clinical
procedures
Are receptive to
change in clinical
procedures
Page 14
Clinician Context Matters
26. Please rate the strength of your agreement with the following statements:
Senior leadership/clinical management in your organization
Provide effective
Neither agree
Agree
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k
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n
j
k
l
m
n
j
k
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m
n
j
k
l
m
n
j
k
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m
n
j
k
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n
j
k
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n
j
k
l
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j
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j
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n
j
k
l
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n
j
k
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j
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j
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j
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n
j
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j
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n
j
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j
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n
j
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n
j
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n
j
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n
j
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n
j
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n
j
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l
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n
j
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n
j
k
l
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n
j
k
l
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n
j
k
l
m
n
j
k
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n
j
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l
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n
j
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n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
k
l
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j
k
l
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n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
management for
continuous
improvement of patient
care
Clearly define areas of
responsibility and
authority for clinical
managers and staff
Promote team building
to solve clinical care
problems
Promote
communication among
clinical services and
units
Provide staff with
information on
community health
center performance
measures and
guidelines
Establish clear goals
for patient care
processes and
outcomes
Provide staff members
with feedback/data on
effects of clinical
decisions
Hold staff members
accountable for
achieving results
Page 15
Clinician Context Matters
27. The PrEP project clinical champion
Neither agree
Agree
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
accepts responsibility
nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
for the success of this
project
has the authority to
carry out the
implementation
is considered a clinical
opinion leader
works well with the
intervention team and
providers
28. Senior leadership/clinical management/staff opinion leaders
Agree on the goals for
Neither agree
Agree
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
this intervention (PrEP
delivery)
Will be informed and
involved in the
intervention (PrEP
delivery)
Agree on adequate
resources to
accomplish the
intervention (PrEP
delivery)
Set a high priority on
the success of the
intervention (PrEP
delivery)
Page 16
Clinician Context Matters
29. The PrEP delivery implementation team members
share responsibility for
Neither agree
Agree
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
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l
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n
j
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l
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n
j
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l
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n
j
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j
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l
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n
j
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l
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j
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n
j
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l
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n
j
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n
j
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j
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l
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n
j
k
l
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n
j
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l
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n
j
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l
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n
j
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l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
the success of the
project (PrEP delivery)
have clearly defined
roles and
responsibilities (for
PrEP delivery)
have release time or
can accomplish
intervention tasks (for
PrEP delivery) within
their regular work load
have staff support and
other resources
required for the project
(PrEP delivery)
30. The implementation plan for this intervention (PrEP delivery)
Identifies specific roles
Neither agree
Agree
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
j
k
l
m
n
j
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j
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j
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l
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n
j
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j
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j
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j
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n
j
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l
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n
j
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n
j
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l
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n
j
k
l
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n
j
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l
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n
j
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l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
and responsibilities
Clearly describes
tasks and timelines
Includes appropriate
provider/patient
education
Acknowledges staff
input and opinions
Page 17
Clinician Context Matters
31. Communication about PrEP delivery will be maintained through
Regular project
Neither agree
Agree
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
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l
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j
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j
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n
j
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j
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j
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n
j
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j
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j
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j
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n
j
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n
j
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l
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n
j
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l
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n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
meetings with the
project champion and
team members
Involvement of quality
management staff in
project planning and
implementation (of
PrEP)
Regular feedback to
clinical management
on progress of (PrEP
delivery) project
activities and resource
needs
Regular feedback to
clinicians on effects of
practice changes on
patient care/outcomes
Page 18
Clinician Context Matters
32. Progress of the PrEP project will be measured by
Neither agree
Agree
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
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l
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n
j
k
l
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n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Collecting feedback
nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
from patients regarding
implemented changes
to provide PrEP
Collecting feedback
from staff regarding
proposed/implemented
changes to provide
PrEP
Developing and
distributing regular
performance measures
to clinical staff
Providing a forum for
presentation/discussion
of results and
implications for
continued
improvements
33. The following are available to make the selected plan for PrEP delivery work
Neither agree
Agree
Staff incentives
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Equipment and
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
j
k
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n
j
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l
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n
j
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n
j
k
l
m
n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
Provider buyin
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Intervention team
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
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l
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n
j
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l
m
n
Evaluation protocol
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
materials
Patient
awareness/need
Page 19
Clinician Context Matters
34. Plans for evaluation and improvement of this intervention (PrEP delivery) include
Neither agree
Agree
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
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n
j
k
l
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n
j
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l
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n
j
k
l
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n
j
k
l
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n
j
k
l
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n
j
k
l
m
n
j
k
l
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n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
Periodic outcome
nor disagree
Disagree
Strongly
Strongly Agree
disagree
Don’t know/NA
measurement
Staff
participation/satisfaction
survey
Patient satisfaction
survey
Dissemination plan for
performance measures
Review of results by
clinical leadership
The last few questions are about your overall assessment of readiness to implement PrEP in your clinic
Page 20
Clinician Context Matters
35. For each of the following statements, please rate the strength of your agreement with
the statement.
I am confident about
Neither agree
Agree
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
nor disagree
Disagree
Strongly
Strongly agree
disagree
Don’t know/NA
my ability to
implement PrEP
where I work.
I believe that I can
overcome barriers in
implementing PrEP.
I am sure about how to
measure the
outcomes of PrEP
clinical care.
I know how to
implement PrEP
sufficiently enough to
make practice
changes.
I am sure that I can
access the best
resources in order to
implement PrEP.
I am sure that
implementing PrEP
will improve the care
that I deliver to my
patients.
I believe that critically
appraising evidence is
an important step in
the PrEP process.
I am clear about the
steps of PrEP.
I am sure that
evidencebased
guidelines can improve
PrEP clinical care.
I believe that EBP
results in the best
Page 21
Clinician Context Matters
clinical care for
patients.
I believe the care that I
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
j
k
l
m
n
deliver is evidence
based
I believe PrEP is
difficult
I believe that PrEP
takes too much time
Thank you for completing this survey
Page 22
| File Type | application/pdf |
| File Modified | 2015-03-06 |
| File Created | 2015-02-23 |