Summary of Changes

Attachment 13 – Summary of Changes

National HIV Behavioral Surveillance (NHBS) System Round 6 (2020-2023) Summary of Changes to Data Collection Instruments

1. Eligibility Screener, Attachments 3a & 4a (3 items deleted):

• Deleted 1 question assessing census tract of residence of HET cycle participants (ES7) and deleted 1 question asking interviewers to indicate whether the participant’s census tract was a high-risk area (ES7a). These items are no longer needed, as residence in a high-risk area is no longer an eligibility requirement for HET cycle seeds.

• Deleted 1 question assessing zip code for HET cycle participants (ES6) from the HET cycle eligibility screener because it is no longer needed as part of the census tract assessment. Instead, zip code will be assessed in the HET cycle using the existing item in the behavioral assessment (DM2).

2. Behavioral Assessment, Attachments 3b-d & 4b-d (9 items added, 105 items deleted, 29 items modified, 17 items moved):

• Emerging priorities in HIV prevention - The HIV prevention landscape has changed significantly in recent years with increased emphasis on Pre-Exposure Prophylaxis (PrEP). The following changes were necessary to ensure NHBS continues to collect the most relevant HIV-associated behavioral data:

  • Measuring use of Pre-Exposure Prophylaxis (PrEP)

    • Added 5 questions measuring stages along the prevention continuum for HIV-negative persons, focusing on PrEP access (PA6d and PA6e), current use (PA6j and PA6k), and adherence (PA6l).

    • Deleted 1 question assessing use of PrEP for 2 or more consecutive months (PA6e), as it is no longer required to distinguish PEP from PrEP use.

    • Deleted 2 questions assessing non-daily PrEP use due to low variability.

• Deletion of lower priority items – Every item in each Behavioral Assessment was reviewed for quality and content value. Items measuring repetitive or low priority content were removed from the assessment.

  • Deleted 16 questions (ID17, ID17conf, ID18-ID26, ID27a, ID27b, ID28a, ID28b, and ID29) assessing detailed risk behaviors during the last time the respondent shared needles or other injection equipment and characteristics of the last person with whom participants shared any injection equipment. Event-level information about injection equipment sharing is not necessary to collect in NHBS. Further, these questions proved difficult for participants to answer.

  • Deleted 67 questions assessing behaviors with and characteristics of participants’ recent sex partners. The level of detail from these questions is not necessary to collect in NHBS. In addition, questions about frequency of sex proved difficult for participants to answer.

    • Deleted 24 questions about the 2^nd to last sex partner (SX51, SX52a, SX52b, SX53, SX54, SX55, SX56a, SX56b.o, SX56b.m, SX57a, SX57b.o, SX57b.m, SX58a, SX58b.o, SX58b.m, SX59a, SX59b.o, SX59b.m, SX60a, SX60b, SX61a, SX61b, SX61c, and SX61d).

    • Deleted 24 questions about the 3^rd to last sex partner (SX62, SX63a, SX63b, SX64, SX65, SX66, SX67a, SX67b.o, SX67b.m, SX68a, SX68b.o, SX68b.m, SX69a, SX69b.o, SX69b.m, SX70a, SX70b.o, SX70b.m, SX71a, SX71b, SX72a, SX72b, SX72c, SX78d).

    • Deleted 12 questions assessing the frequency of sex with the last partner (SX43a, SX43b.o, SX43b.m, SX44a, SX44b.o, SX44b.m, SX45a, SX45b.o, SX45b.m, SX46a, SX46b.o, SX46b.m).

    • Deleted 4 questions assessing the number of sex partners in the past 3 months (SX27a, SX27b, SX27c, SX27d). These 4 questions served only as a filter for the frequency of sex questions, which were deleted.

    • Deleted 3 questions (SX28, SX29, SX30) assessing partner initials to help participants accurately report partner-specific behaviors and characteristics. These items are no longer necessary, as participants will no longer be asked to recall partner specific information for more than 1 recent sex partner.

  • Deleted 21 questions determined to yield low priority data, data with insufficient variability to conduct meaningful analysis, or the measure had low internal consistency.

    • HT3 – number of times tested for HIV in the past 2 years

    • HT5 – number of times tested self for HIV with a rapid home test in past 12 months

    • HT7b, HT7c – partner services after first HIV-positive test

    • HT11, HT12, HT13, HT14 – HIV stigma

    • JT2 – HIV testing while incarcerated in past 12 months

    • SO5 – use of internet or social media to meet other MSM

    • SX36 – type of location in which MSM met their last sex partner

    • SX49conf – confirmation of oral sex but not vaginal or anal sex at last sex

    • SX73a, SX73b, SX74a – SX74g – hormonal contraceptive use

• Measurement improvements – Modifications were made to items with potential to yield higher quality or more directly relevant data based on lessons learned from previous NHBS data collections and analyses.

  • Added 4 questions (SX49c, SX49d, SX49e, SX49f) assessing role-specific (i.e., insertive vs. receptive) anal sex and condom use for each behavior during the last sex event, if the participant and last partner are both male.

  • Modified 1 question assessing household income (DM7) two response options to accommodate relevant income categories in areas with higher cost of living. Wording of this item was also modified to clarify the recall period.

  • Modified 1 question assessing number of dependents on income (DM7a) and capped the highest value that can be entered to limit possible entry of invalid values.

• Clarity, repetitive language, and interview flow - Based on a review of all items in the Behavioral Assessments, the wording of 27 items was changed to accommodate the deletion of references to partner initials, which were no longer needed with the deletion of questions about the 2^nd and 3^rd to last sex partners. An additional 17 items were moved to improve interview flow, including 14 questions assessing date of last sex, partner characteristics and risk history, and partner concurrency. These changes do not affect the scope or content of the questions; they also do not affect the time burden of NHBS to participants. However, they are intended to improve the overall participant experience and the quality of data by improving clarity and flow of the interview process.

  • Modified 2 Introductory statements (INTRO_LP Series, INTRO_SX40a)

  • Modified 25 questions

    • 7 questions measuring characteristics of the last sex partner (SX31, SX32a, SX32b, SX33, SX34, SX35a, SX35b

    • 4 questions measuring risk history of the last sex partner (SX37a, SX37b, SX38, SX39)

    • 4 questions measuring concurrent sex partners (SX40a, SX40b, SX41a, SX41b)

    • 6 questions about behaviors during the last sex (SX47a, SX47b, SX48a, SX48b, SX49a, SX49b)

    • 4 questions about HIV status of and ART use by the last sex partner (SX50a-SX50d)

  • Moved 17 Questions to improve interview flow:

    • 2 questions measuring last sex partner’s age (SX32a & SX32b)

    • 1 question measuring last sex partner’s race/ethnicity (SX33)

    • 2 questions measuring relationship length with last sex partner (SX35a & SX35b)

    • 4 questions measuring participant’s knowledge of last partner risk history (SX37a, SX37b, SX38, SX39)

    • 4 questions measuring concurrent sex partners during relationship with last sex partner (SX40a, SX40b, SX41a, SX41b)

    • 1 question measuring the date of last sex (SX42)

    • 1 question measuring the maximum number of alcoholic drinks consumed (AL2)

    • 2 questions measuring incarceration history (JT1, JT1a)