In-Depth Interview Guide

Form Approved

OMB No. 0920-New

Expiration Date: XX/XX/XXXX

Understanding HIV/STD Risk and Enhancing PrEP Implementation Messaging in a Diverse Community-Based Sample of Gay, Bisexual, and Other Men Who Have Sex with Men in a Transformational Era (MIC-DROP)

Attachment 4h

In-Depth Interview Guide English

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Exploring Longitudinal Experiences with PrEP

In-Depth Interview Guide

• Participant has completed consent

• Recorders turned on

• Interviewer note: Probes are designed to facilitate conversation; not all probes will be used in each interview. Ask probes that reflect the conversation direction provided by participant.

RESPONDENT ID: ________

INTERVIEWER INITIALS (XXX): _______

DATE: _________ START TIME: __:__AM/PM

Introduction and Interview Purpose

Welcome and thank you again for agreeing to be interviewed. 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. 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?

1. TOPIC: Knowledge regarding different types of PrEP medication

PROBES/ACTIVITIES

1. Let’s begin by talking about different types of PrEP. Can you describe the different ways you know that PrEP pills can be taken?

2. Tell me about your thoughts about non-daily (2-1-1) PrEP?

3. Tell me about what you know about injectable (long-acting) PrEP?

4. Tell me what you know about different types of oral PrEP medication (e.g. Truvada-based and Descovy-based regimens)?

5. How might these different PrEP modalities fit into your life? Which ones are best for you and why?

6. (for those using PrEP) Can you talk about some positive or negative emotions you get from using PrEP?

2. TOPIC: PrEP discussions

PROBES/ACTIVITIES

1. Tell me about people you have discussed PrEP with, and what have those conversations have been like?

2. [if a clinician] Who initiated the conversation, and did you receive all the information you were seeking? What did you talk about?

   1. Did you talk about side effects, different PrEP options, issues with adherence, or issues with condom use?

3. [if friends/partner] How the topic come up? How often is PrEP discussed, and how do these conversations usually go?

   1. Did you talk about side effects, different PrEP options, issues with adherence, or issues with condom use?

4. [if partner] How does PrEP work in the context of your sexual relationships?

   1. What is your perceived risk for different types of partners?

1. TOPIC: [If used PrEP before] Past use of PrEP

PROBES/ACTIVITIES

1. Tell me about when you have used PrEP in the past?

2. How long did you use it for, and in what ways did you use it?

3. Why did you stop using PrEP? (or) Why are you continuing to use PrEP? Why did you restart taking PrEP?

4. What makes PrEP right for you or another person?

5. What would make PrEP not the right thing for you or another person?

1. TOPIC: [If never used PrEP] Planning to start PrEP

PROBES/ACTIVITIES

1. Tell me about what made you want to start using PrEP?

2. How long do you plan to use PrEP?

3. How will you use PrEP in terms of dosing/regimen? (2-1-1 or daily or injectable)

4. What makes PrEP right for you or another person?

5. What would make PrEP not the right thing for you or another person?

1. TOPIC: Future intended use of PrEP

PROBES/ACTIVITIES

1. Think about the next 6 months. Over this period, what things might influence how you use PrEP?

2. How long do you think you will continue to use PrEP, and why do you think that is the length of time you will use it?

1. TOPIC: Positive sexual health messages to support PrEP use

PROBES/ACTIVITIES

1. We are considering adding some positive health messages to our standard HIV prevention messages. These would be mixed in delivery with standard PrEP promotion messages. Please read this message out loud, then tell me your thoughts about the message.

2. Does the idea of having some health messages that do not address condoms, HIV testing, and PrEP appeal to you?

3. What kinds of positive health messages would you prefer to receive: content only, content and resources, or both?

4. What formats would you want positive health messages to be delivered in?

1. TOPIC: PrEP journey

PROBES/ACTIVITIES

1. What has you PrEP journey been like over the past 6 months?

2. Tell me about how you have thought about PrEP over the last 6 months?

3. Please describe any moment in the last 6 months when you might have thought about stopping PrEP, or taking PrEP less frequently.

   1. What do you think led to this?

   2. How did you ultimately decide to stop taking or continue taking PrEP?

4. Tell me if anything in your life has changed in the last 6 months to influence how you might use PrEP?

5. Please describe any moment in the last 6 months when you might have thought about starting PrEP, or taking PrEP more frequently.

   1. What do you think led to this?

   2. How did you ultimately decide to stop taking or continue taking PrEP?

6. Tell me about anything that makes getting PrEP challenging or easy?

7. Let’s talk about different PrEP options and whether they would or would not have influenced your PrEP use in the last 6 months:

   1. Access to different places to get PrEP, e.g. pharmacy or mail delivery

   2. Access to different PrEP modalities, such as 2-1-1 or injectable PrEP

   3. Access to a peer counselor to talk with about PrEP

   4. Messaging to remind you to take PrEP

   5. Ability to access PrEP over the pharmacy counter, with you self-managing aspects such as a home HIV testing

For follow-up in-depth interviews, the guide will include probes that use quotes from the previous interview with that participant. The participant will be shown their own words from the previous period, and will be asked to contrast how their current experience is similar or differs from the prior statements. This will be accomplished in follow-up interviews by (1) asking the question as stated in the guide; (2) the participant provides their response to the question, (3) the participant is shown key quotes from their previous answer to the same question, and (4) the participant discusses how their opinion has stayed the same or changed over time, and why.

Appendix A: Information about PrEP modalities, provided if individuals or groups are unaware of these modalities

Pre-exposure prophylaxis (PrEP) is taking an antiretroviral medicine, either as a pill (also called Truvada or Descovy) or as an injection (also known as Apretude) given every 2 months, to reduce a person's chance of getting HIV.  PrEP helps prevent HIV infection for HIV-negative persons. PrEP is currently available in the form of (1) a daily pill, (2) on-demand or event-driven pill (2-1-1 pill dosing around the time of sex), and long-acting injectable administered by a provider every 2 months.  

Daily oral PrEP is a pill that a person who is HIV-negative takes every day in order to prevent getting HIV. PrEP is safe, but some people experience side effects like diarrhea, nausea, headache, fatigue, and stomach pain when taking a common PrEP medication. These side effects usually go away over time. You have to see a doctor or other healthcare provider to start daily oral PrEP and go back for check-ups once every 3 months to stay on it. Studies have shown that daily oral PrEP provides about 99% protection against HIV infection from sex when it is taken every day. 

There is a way that some people take PrEP pills called on-demand oral PrEP. On-demand oral PrEP is also known as “intermittent”, “2-1-1” or “event-driven” PrEP. With on-demand oral PrEP you take a series of pills around the time when you have sex. This means taking two pills 2 to 24 hours before sex, one pill 24 hours after the first dose, and one pill 24 hours after the second dose. Some studies found that on-demand PrEP is effective at preventing HIV infection.

A long-acting form of PrEP that is given as an injection in your buttocks once every 2 months has been found to be effective in preventing HIV infection. You would have to see a doctor or healthcare provider to start injectable PrEP and go back for check-ups once every 2 months to stay on it. The possible side effects of injectable PrEP are mild-to-moderate pain at the injection site that lasts 2 to 7 days, mild rash at the injection site that clears up on its own, or a headache that lasts a couple of days after injection. Studies have found that injectable PrEP is effective at preventing HIV infection. 

PEP, or post-exposure prophylaxis, is antiretroviral pills taken for 28 days only after having condomless sex for people not taking PrEP, to prevention HIV infection.  

Appendix B: Additional Messages

Messages about 2-1-1 PrEP

If you are considering stopping daily PrEP because you have sex less frequently, 2-1-1 PrEP is highly effective in preventing HIV and is a good option. Learn more here.

Consider talking to your doctor about 2-1-1 PrEP if you think this might be right for you. Non-daily PrEP is highly effective when taken on schedule.

Think that PrEP just isn’t right for you? There are many options, including non-daily dosing (2-1-1) and long-acting injectables. These can help address concerns about side effects or daily dosing. Find a doctor to discuss PrEP here.

Interested in minimizing the side effects of PrEP pills? 2-1-1 dosing might be right for you. Find out more here.

2-1-1 PrEP is when you take PrEP only when you have sex: two pills 2-24 hours before sex, one pill 24 hours after the initial dose, and one final pill 24 hours later. Find a PrEP provider here.

Messages about PrEP Side Effects

Did you know one study favorably compared the side effects of PrEP to Aspirin? PrEP side effects tend to be mild, and to go away after the first month of use.

Did you know that any long-term effects of being on PrEP, such as the rare case when people lose bone mineral density, reverse once you discontinue PrEP?

There are new formulations of PrEP that each have different side effects. Find one that works for you, talk to a PrEP provider today.

Did you know that different formulations of PrEP have different impact on weight loss and gain? Find out more here, or talk to your doctor.

Daily oral PrEP has “start-up” side effects, such as upset stomach, for the first month of use. After that period, most users do not have these types of side effects. Learn more about short-term PrEP side effects here.

Many people are concerned about the long-term effects of being on PrEP, but few are aware of the research showing that any negative impacts of taking PrEP reverse once you discontinue.

PrEP side effects can occur, but usually fade within the first month. Talk to your provider if you experience upset stomach, headache or vomiting that doesn’t go away.

Fever or chills are relatively rare side effects of PrEP use. Contact your doctor immediately if you experience these symptoms.

Messages about long-acting injectable PrEP

If taking pills doesn’t work for your life, there is a new PrEP option. Injectable PrEP prevents HIV without needing to take pills. Find a provider here.

If you have trouble remembering to take PrEP pills, injectable PrEP can give you full protection. Find out more here.