0920-1266 ChiCAS Interview - English JUN2021

ChiCAS interview guide

Form Approved

OMB No: 0920-1266

Exp. Date: 06/30/2021

HIV prevention among Latina transgender women who have sex with men:

Evaluation of a locally developed intervention

Attachment 4e

ChiCAS Interview English

Instructions for Qualitative Interviews

We want to understand both the barriers and the facilitators to improved health through participation in the ChiCAS intervention. We will tailor each interview to meet each participant’s outcomes. Thus, before the interview, the interviewer will need to know the results of the intervention for each participant selected for interviewing. Dr. Song will examine the 6-month follow-up data and randomly select participants who are eligible. Specifically, we interview:

1. Participants who reported an increase in at least one HIV prevention behavioral outcome (PrEP or condom use) and who reported an increase in the use of medically supervised hormone therapy (n=10).

For this group of participants, the interviewer will need to know which of the intervention-targeted behaviors each participant increased. For the behaviors they increased, the interviewer will ask/probe more about what helped them improve.

2. Participants who did not report an increase in at least one HIV prevention behavioral outcome (PrEP or condom use) and did not report an increase in the use of medically supervised hormone therapy (n=10).

Because these participants will not have increased any behaviors targeted by the intervention, the interview will focus on asking what barriers each participant faced and what could have been done in the intervention to help support behavior changes.

3. Participants with mixed results (n=10).

For this group of participants, the interviewer will need to know which of the intervention-targeted behaviors each participant increased and which they did not. For the behavior(s) they increased, the interviewer will ask/probe more about what helped them improve. For the behavior(s) they did not increase, the interviewer will ask/probe about the barriers they faced what could be done in the intervention to help support behavior changes.

Form Approved

OMB No: 0920-1266

Exp. Date: 06/30/2021

Privacy Act Statement:

This information is collected under the authority of the Public Health Service Act, Section 301, "Research and Investigation," (42 U.S.C. 241); and Sections 304, 306 and 308(d) which discuss authority to maintain data and provide privacy for health research and related activities (42 U.S.C. 242 b, k, and m(d)). This information is also being collected in conjunction with the provisions of the Government Paperwork Elimination Act and the Paperwork Reduction Act (PRA). This information will only be used by the Centers for Disease Control and Prevention (CDC) staff to evaluate the efficacy of the locally developed ChiCAS HIV prevention intervention for Hispanic/Latina transgender women.

Public reporting burden of this collection of information is estimated to average 90 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)

Participant ID _____________

Qualitative In-depth Interviews: Post-intervention

Thanks for taking the time to meet with me. My name is __________, and I work in the Department of Social Sciences and Health Policy at Wake Forest School of Medicine, and collaborated with Triad Health Project and the University of North Carolina Greensboro on the ChiCAS project. You have been involved with the ChiCAS project, and I’d like to talk to you about your experience.

There are no right or wrong answers. You are the expert on your experiences and your opinions and thoughts are very valuable. We hope that you can help us make ChiCAS even better!

We would like to record our conversation if that is acceptable to you because it will be hard for me to remember everything you say. Would you agree to allow me to record our conversation? You can ask me to turn it off at any time. The information that we gather in this interview and the digital recording will be kept confidential and in a safe place.

ChiCAS Project: General experiences & recommendations

To begin, I’d like to talk to you about your experiences generally with the ChiCAS project, and then later we’ll talk about some of the specific health topics that the ChiCAS project focused on.

1. Tell me about your experiences with the ChiCAS project.

• Probes

  • How did you find out about ChiCAS?

  • Did you have any reservations about participating?

  • Why did you decide to be part of the project?

  • What areyour impressions of the ChiCAS coordinators - Ms. Refugio Aviles and Mr. Alonzo?

• How did you communicate with them? (text, phone, Facebook, social media/network apps)

2. What activities during the ChiCAS project worked really well for you? And what activities didn’t work well for you?

• Probes: [Provide some examples of activities.]

  • What do you think is the most valuable information you learned from participating in ChiCAS? What activities were the most memorable?

  • How would you change/improve the activities that didn’t work well?

3. Tell me about what you talked to others (e.g., friends, family, partners, and other Latina transgender women) in terms of what you learned through your participation in the ChiCAS project?

PrEP: Awareness, experiences, & lessons learned

Now I’d like you to think about your attitudes and behaviors about PrEP (pre-exposure prophylaxis) since participating in ChiCAS.

4. How would you say your knowledge/awareness/interest/use about PrEP changed?

• What would you say helped promote these changes?

• What steps have you taken to use PrEP (e.g., discussed with a provider, started taking it, etc)?

5. Tell me about what you found useful in this project related to PrEP. Tell me about what you didn’t find useful.

6. What could ChiCAS have been done better to help support you and others to use PrEP?

7. Are there other factors, outside of the ChiCAS project that have contributed to help you be able to/not be able use PrEP?

   • Probes:

   • Barriers (e.g., health insurance, knowing where to go to get PrEP, transportation, provider communication, language, clinic discrimination)

   • Facilitators (e.g., friend/partner social support, provider assistance)

Condom use: Experiences & lessons learned

Now I’d like you to think about your condom use behaviors since participating in ChiCAS. Remember there are no right or wrong answers; we want to improve our project with your valuable feedback.

8. Tell me about your current condom use.

• If you’re using condoms, what helps you initiate using them with a partner?

• What barriers do you face when using condoms?

• Tell me about using condoms with different kinds of partners (e.g., a regular partner vs. somebody you just met)

9. Tell me about your ability to talk about condom use with sexual partners.

• If you’re talking about condoms, what helps you start talking about condoms?

• Do you “negotiate” condom use with your sexual partners more than before?

• How do you react when a partner doesn’t want to use a condom with you?

• How do you react when a partner doesn’t want to use a condom with you?

10. How have alcohol and/or drugs influenced what you do in terms of condom use?

11. Do you think it would be hard for someone to use a condom if their partner was paying them for sex? Why or why not?

• If you know anyone who does sex work, tell me what you have heard about what kind of experiences these women have had regarding their clients and their willingness to use or not use condoms.(e.g., is it common for clients not to want to use condoms? Does it happen that they want to pay more to not use condoms? That you know of, do the women agree not to use a condom if more money is offered?)

12. Tell me about what you found useful in this project related to condoms. Tell me about what you didn’t find useful.

13. What could have been done better in ChiCAS to help you and others use condoms more?

Transition-related services: Experiences & lessons learned

Now I’d like you to think about your use of medically supervised hormone therapy since participating in ChiCAS.

14. Tell me about your past and current use of any services or “products” for gender transition?

    • What have you used (e.g., hormones, any type of body enhancement implants such as silicone, mental health services) and where did you get it (e.g., doctor, tienda, other)?

15. How has your knowledge/awareness/interest/use about hormone therapy changed?

    • What has helped promote or support these changes?

    • What steps have you taken to use medically supervised hormone therapy (e.g., discussed with a provider, started taking it, etc)?

16. What are the barriers to taking steps to get transition-related services?

    • Probe:

      • Do you have health insurance?

      • Do you know where to go to get transition-related services?

      • Is transportation to the medical appointment or to a clinic a barrier for you?

      • Do you feel comfortable talking about your gender identity and transition with a doctor?

      • Do you think you’d be discriminated against when you go to a clinic?

      • Do you feel like language is a barrier?

17. Tell me about what you found useful in the ChiCAS project related to hormone therapy.

18. Tell me about what you didn’t find useful.

19. What could have been done better to help support you and others to use medically supervised hormone therapy? Other transition-related services?

20. Are there other factors, outside of the ChiCAS project, that have contributed to help you be able (or not being able) to use medically supervised hormone therapy?

    • Probes:

    • Barriers (e.g., health insurance, knowing where to go to get hormone therapy, transportation, provider communication, language, clinic discrimination)

    • Facilitators (e.g., friend/partner social support, provider assistance)

Other questions: Helpful for understanding context (and future work)

21. What other priorities do you have about your sexual health? Your health in general?

22. Tell me about any discrimination or violence you have experienced because of:

    • Probe:

    • Your race or ethnicity?

    • Your sexual orientation?

    • Your gender identity?

    • Your immigration status?

      • Where did this take place? In the US or in your country of origin?

Conclusion: Thank you.

You have really helped me a great deal today. We have covered everything that I wanted to cover.

23. Do you have anything that you’d like to share with me or do you have any further thoughts about what we talked about today?

Thank you so much for your time today and your participation in ChiCAS!

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