Att 3 Verbal Informed Consent

Att 3_Verbal Informed Consent.docx

Formative Research and Tool Development

Att 3 Verbal Informed Consent

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Attachment 3

Improving Surveillance Data Collection among Persons Not Receiving HIV Care: A Qualitative Project to Enhance the Medical Monitoring Project


You were chosen for this project based on some information you provided during the Medical Monitoring Project (MMP) survey. Taking part in this project is up to you. You can choose to participate or not. Your decision to participate in this project will not affect any services you use or the token of appreciation you received for MMP. If you change your mind about participating, you may stop the interview at any time.


Why we are doing this project?

Your health department and the Centers for Disease Control and Prevention (CDC) are doing this project to understand how some people living with HIV think about receiving routine HIV medical care. We are interested in your thoughts because this will help us improve how we collect information through MMP about HIV medical care. This information will help improve programs that keep people healthy and get them the help they need.


What we will need from you?

If you take part in this project, you will be asked to answer questions about your HIV medical care in an audio-recorded telephone interview. You do not have to answer any question you do not want to answer.


The questions ask about:

  • The healthcare you receive for HIV

  • The kinds of things that help or make it hard to get healthcare for HIV

  • How the healthcare you receive for HIV has affected you


What you can expect from us?

We will protect your privacy. All information you give us will be kept private and confidential as much as the law allows.


We may publish what we learn from this project. A code number will link your answers from the MMP interview to this interview. However, your answers will be grouped together with answers from other respondents so that no one will know your name or which answers are yours. Federal law protects the confidentiality of information kept at the CDC.


What do you get for your participation?

You will receive a token of appreciation for taking part in the project. If you choose to stop the interview early, you may still keep the token of appreciation.


What else should you consider?

  • There is no cost to you (other than your time and effort) for being in this project.

  • If you like, we can give you information about how to avoid giving HIV to someone else or information about where to get medical and social services.

  • There are no direct benefits from being in this project. However, the information you give us can help us improve services available to other people living with HIV.

  • Some of the questions may make you feel uncomfortable or may be personal.

  • Remember: You do not have to answer any questions you do not wish to answer.

  • In order to participate, we need your permission to audio record this interview.


Questions?


Do you have questions about what I just said?

Respondent’s Consent Statement


Would you like to participate in an audio-recorded interview?


Contact Information


For questions about this project or your rights, please contact CDC at 1-404-639-6475. Please leave a brief message saying that you are calling in reference to the Qualitative Medical Monitoring Project and give us a way to contact you. Someone will return your call as soon as possible.


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorGreen, Shana (CDC)
File Modified0000-00-00
File Created2021-01-21

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