Survey

Clinician Context Matters

Public reporting burden of this collection of information is estimated to average 30 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 of 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 reporting 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, GA 30333:
Form Approved OMB No.0920-1058 Exp Date 03/31/2018

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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
study-specific 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
dsmith1@cdc.gov.

* 1. Please enter your confidential ID number
ID number

* 2. Please enter the city in which your clinic is located
Chicago - Access
Washington, DC
Philadelphia

Chicago - HB
Jackson, MS

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* 3.
Do you agree to complete the survey?
I agree to participate in the survey
I do not agree to participate in the survey this year.

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Clinician Context Matters

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)
Physician
Nurse Practitioner
Registered Nurse
Physician's Assistant
Medical Assistant
Pharmacist
Other (please specify profession/occupation)

5. Which best describes your professional training or specialization? (Choose one)
General Adult Medicine
Pediatrics/Adolescent Health
Women’s Health/Obstetrics/Gynecology
Infectious Disease/STI
HIV Medicine
Other (please specify training/specialization)

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?
Male
Female

9. Do you consider yourself to be...?
Heterosexual or "Straight"
Homosexual, Gay, or Lesbian
Bisexual
Other (please specify)

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Clinician Context Matters

10. Do you consider yourself Hispanic or Latino(a)?
Yes
No

11. Which race you consider yourself (choose any):
White
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander

12. In what country were you born?
United States (including Puerto Rico, Guam, US Virgin Islands, or Northern Marianas)
Other country (please specify)

13. What year did you come to live in the United States?
Year

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Clinician Context Matters

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 (13-17 years)

Injecting drug users (currently injecting)

15. In an average month, for approximately how many HIV-infected 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)

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17. For approximately how many HIV-uninfected patients have you ever prescribed 28 days of
antiretrovirals for nonoccupational postexposure prophylaxis (nPEP)
Number patients ever prescribed nPEP

18. For approximately how many HIV-uninfected patients have you ever prescribed/provided antiretrovirals
for PrEP
Number patients ever prescribed PrEP

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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)

All new patients

Any patients I feel Any patients that I
are at moderate risk suspect are at high
for getting HIV
risk for getting HIV
infection
infection

Only for patients
who bring it up

For no patients

Take a sexual activity
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)

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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
with Truvada

Provide PrEP
with an
Adjust the dose
alternative drug of Truvada for
regimen
PrEP

Withold PrEP
until specific
conditions met

Discontinue
PrEP with
Truvada

Not Sure/Don’t
Know

Patient has an 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 undetectable
viral load

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Provide PrEP
with Truvada

Provide PrEP
with an
Adjust the dose
alternative drug of Truvada for
regimen
PrEP

Withold PrEP
until specific
conditions met

Discontinue
PrEP with
Truvada

Not Sure/Don’t
Know

Patient has been on
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

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Clinician Context Matters

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.

21. Please rate your agreement or disagreement with each statement.
(One response per row)
Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

Clinical experience is
more important than
randomized controlled
trials
I am comfortable
practicing in ways
different than other
doctors
Evidence-based
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

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Strongly Agree

Agree

Neutral

Disagree

Strongly Disagree

I am uncomfortable
doing things differently
from the way I was
trained
I am often critical of
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
Evidence-based
medicine is not very
practical in real patient
care

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Clinician Context Matters

The next set of questions are about your assessment of changes in clinical practice related to implementing PrEP at your clinic

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.
Very weak

Weak

Neither weak
nor strong

Strong

Very Strong

Don’t know/NA

Based on your own
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

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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:

Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

are(is) supported by
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 center
patients

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Clinician Context Matters

24. Please rate the strength of your agreement with the following statements:
Senior leadership/clinical management in your organization
Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

Strongly
disagree

Don’t know/NA

Reward clinical
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

25. Please rate the strength of your agreement with the following statements:
Staff members in your organization

Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Have a sense of
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

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26. Please rate the strength of your agreement with the following statements:
Senior leadership/clinical management in your organization

Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

Provide effective
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

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Clinician Context Matters

27. The PrEP project clinical champion
Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

Disagree

Strongly
disagree

Don’t know/NA

accepts responsibility 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
Strongly Agree

Agree

Neither agree
nor disagree

Agree on the goals for
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)

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Clinician Context Matters

29. The PrEP delivery implementation team members
Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

Disagree

Strongly
disagree

Don’t know/NA

share responsibility for
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)
Strongly Agree

Agree

Neither agree
nor disagree

Identifies specific roles
and responsibilities
Clearly describes tasks
and timelines
Includes appropriate
provider/patient
education
Acknowledges staff input
and opinions

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Clinician Context Matters

31. Communication about PrEP delivery will be maintained through
Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

Regular project 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

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32. Progress of the PrEP project will be measured by
Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

Collecting feedback 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

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Clinician Context Matters

33. The following are available to make the selected plan for PrEP delivery work
Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

Staff incentives
Equipment and materials
Patient awareness/need
Provider buy-in
Intervention team
Evaluation protocol

34. Plans for evaluation and improvement of this intervention (PrEP delivery) include
Strongly Agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

Periodic outcome
measurement
Staff
participation/satisfaction
survey
Patient satisfaction
survey
Dissemination plan for
performance measures
Review of results by
clinical leadership

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Clinician Context Matters

The last few questions are about your overall assessment of readiness to implement PrEP in your clinic

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35. For each of the following statements, please rate the strength of your agreement with the statement.
Strongly agree

Agree

Neither agree
nor disagree

Disagree

Strongly
disagree

Don’t know/NA

I am confident about 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 clinical care
for patients.
I believe the care that I
deliver is evidencebased
I believe PrEP is difficult
I believe that PrEP takes
too much time

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Clinician Context Matters

Thank you for completing this survey

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