PrEP Semi-Structured In-Depth Interview Guide

Form Approved

OMB No. 0920-New

Expiration Date: XX/XX/XXXX

Understanding Decisions and Barriers about PrEP Use and Uptake Among Men Who Have Sex With Men

Attachment # 3c

In-depth Interview Guide

Public reporting burden of this collection of information is estimated to average 45 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)

Understanding PrEP Refusers/Unsuccessful Initiators

Semi-Structured In-Depth Interview Guide

• Administered Re-Screener - R qualifies as Refuser

• Administered Re-Screener - R qualifies as Unsuccessful Initiator

• Completed Consent

• Turned on Recorders

RESPONDENT ID: ________

INTERVIEWER INITIALS (XXX): _______

DATE: _________ START TIME: __:__AM/PM

Introduction and Interview Purpose

Welcome and thank you again for agreeing to participate in this study. My name is ________ and I am part of a research team working to understand different perspectives on HIV prevention. During our discussion we will be talking about sex, HIV, prevention, PrEP, and related topics. We want to hear about what you know, think and believe. There are no right or wrong answers to the questions I’m going to ask. I want to hear, in your own words, your thoughts, experiences and opinions about the topics we’ll be discussing. Please remember that you can choose not to respond to a question at any time and that your participation in this study is completely voluntary.

Do you have any questions before we begin?

Section I: PrEP Use and Health Seeking Behavior

Subsection A: Questions about PrEP & reflections on the encounter when offered PrEP

I am going to start by asking you some questions about PrEP and your health care. PrEP, or pre-exposure prophylaxis, is a pill – sometimes referred to as Truvada – you can take every day and it will help prevent you from becoming infected if exposed to the HIV virus. In studies, it reduces a person’s chance of becoming infected with HIV by up to 92%.

1. Let’s talk about PrEP. Beyond what I just said, what else do you know about PrEP?

1. What is your gut feeling about PrEP?

2. What do your friends, your family, and media say about PrEP?

Probe for any missing groups - be sure participants have discussed the groups listed

3. What has had the most influence on your decision regarding PrEP, and why?

Probe for concerns such as side effects, cost and access

4. Tell me about any “peer pressure” to take, or not take, PrEP.

1. How have your friends or the community in general treated those who are on PrEP? Have you heard the expression, “PrEP whore” or “Truvada whore?”

What do you think about this label?

Probe: pressure from friends, pressure from the LGBTQ community in general, or family.

5. Tell me about the most recent appointment where you were offered PrEP.

1. Who offered PrEP? What did they tell you about PrEP? Pros and cons?

2. What reasons did they give you about why they think you should take PrEP?

3. What do you think about those reasons?

REFUSERS ONLY: 6R. Why do you feel PrEP isn’t right for you? Check your understanding of what they said – paraphrase what they have said about the last question and provide them an opportunity to clarify any misunderstanding or to expand on your paraphrase. Probe: If you change your mind about PrEP, do you know what to do to get PrEP?

UNSUCCESSFUL INITIATORS ONLY: 6U. Why did you think it was right for you at the time of the appointment? What has changed/ happened since then? Check your understanding of what they said – paraphrase what they have said about the last question and provide them an opportunity to clarify any misunderstanding or to expand on your paraphrase. 6Ua: Tell me about any concerns or barriers you think might prevent you from getting back on PrEP?

Subsection B: General health seeking behavior, engaging with providers, etc.

7. Tell me about your healthcare; for example, how often do you see a doctor and for what reasons?

a) How often do you get tested for HIV.

7. Do you think there is a difference between taking PrEP and a daily vitamin or any other pill you might take daily?

Probe: for clarity on what they feel is the difference between these two behaviors, if there is a difference.

Section II: HIV and STDs

Subsection A: Questions about what you know, how you know, who you know, experiences with HIV/STDs, perceived HIV/STD risk.

Now I am going to ask you some general questions about your thoughts and experiences with HIV and STDs.

7. What sexually transmitted diseases have you been diagnosed with in your lifetime? How concerned are you with getting an STD?

If they are unsure of the name, show them the chart of STDs and let them select from the list. This list is not comprehensive so there are others they mention. The point is to get at what they think are STDs, not what are “official” STDs.

7. How concerned are you about getting HIV?

1. Why are you, or are you not concerned?

7. Tell me how you protect yourself from HIV.

Probe: condom use; serosorting (selecting only partners of the same HIV status, so other HIV negative people); seropositioning (only taking the inserter/top role during anal sex), abstinence

7. How confident you are that you will remain HIV negative? Why?

7. Tell me about a personal experience you have had with HIV, either through family, a friend, or a partner.

Section III: HIV Sexual Risk Behavior

Subsection A: Questions about partners, condom use/perception/opinion, sexual negotiation, last unprotected sex act as context for questions

Now I am going to switch gears and ask you to talk in more detail about a recent sexual experience. Remember, you can choose not to answer at any time if the questions make you feel uncomfortable.

7. I want you to think about a recent sexual experience where you did not use a condom and answer the next questions about that experience.

1. Who did you have sex with: a primary partner, casual partner, or someone else?

2. Where did this experience occur: at your home, the partner’s home, or in a semi/public space?

3. What happened? Tell me more about this experience.

4. Why didn’t you use a condom?

5. How often do you use condoms?

6. How do you feel about condoms?

7. How does recreational drug and/or alcohol use influence what you do sexually, with whom, and the risks you take during sex, if at all?

Subsection B: Questions about PrEP with different types of partners or sex behaviors

7. Has someone ever decided not to have sex with you because you are not on PrEP?

a. IF YES: Tell me about this encounter.

Subsection C: PrEP decision elicitation

7. Do you think PrEP would be a good choice for you if your situation or risk changed? Why or why not?

1. Are there other personal factors, not related to sex, that influence how well you would do on PrEP or if you should be on PrEP?

2. What would change your mind about PrEP?

3. Would you use PrEP if it were free or cheap?

Probe for any possible issues related to perceived or known side effects.

Check for understanding – paraphrase what they said to this question and the probes asked. Ask if this is a good summary of how they feel/what they believe and let them clarify or add details accordingly.

Section IV: Prevention/Future Options

Subsection A: Questions about different types of PrEP delivery, microbicide, dosing options

We are almost finished and I just have some final questions to ask you about potential future ways to take PrEP.

7. If PrEP could be taken 2-24 hours before and then 48-72 hours after a risky encounter, like unprotected sex, would you take PrEP? Why or why not?

1. Would you take PrEP if…

1. It could be administered once a month as an injectable?

2. It could be applied as a lubricant?

Closing

Thank you for your time and thoughtful responses. That is all the questions that I have for you. Is there anything else that you think we should know that I did not ask about?

[Pause for participant response]

Thanks again for your time.

END TIME: __:__AM/PM