Form 0920-25-0177 Acceptability Survey

Form Approved

OMB No. 0920-1357

Expiration Date: XX\XX\XXXX

The Greater Access and Impact with NAT (GAIN) Study: Improving HIV Diagnosis, Linkage to Care, and Prevention Services with HIV Point-of-Care Nucleic Acid Tests (NATs)

Attachment 4d

Acceptability Survey

Public reporting burden of this collection of information is estimated to average 20 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 (0920-1357)

Survey ID Link

GAIN Madison (Aim 3) CASI

Page 1

Record ID

GAIN Study ID

GAIN Study ID (second entry)

The study IDs do not match. Please correct.

GAIN Madison (Aim 3) CASI

We are asking you to complete this survey because you recently participated in the GAIN study.

We want to understand your experience with getting the point-of-care nucleic acid test (POC NAT). We will ask you questions about yourself, your participation in the study, and your experience with the POC NAT used at your recent visit.

Considering that some of the questions may be about sensitive topics, we suggest taking this survey in a private location.

This survey is completely voluntary, and you may stop at any time. We expect this survey to take about 20 minutes. After you finish taking the survey we will send you a $10 gift card for your time.

Please do not use your browser's back button. If you do, you might have to restart the survey from the beginning. Instead, please use the "Previous Page" button if you need to go back to an earlier question.

If you have any questions or concerns, please contact Joanne Stekler (206-744-8312) or email our study team at GainStudy@uw.edu.

Thank you for your participation! Please click the 'NEXT' button to begin the survey.

Form Approved OMB No. 0920-1357

Expiration Date: XX\XX\XXXX

Public reporting burden of this collection of information is estimated to average 20 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 (0920-1357)

Please let us know your thoughts on the POC NAT that you had at your study visit.

When did you get your POC NAT result? During my appointment After my appointment

I didn't get my results

How did you get your POC NAT result? In clinic by my provider In clinic by the study staff By phone by my provider By phone by study staff

Via my electronic medical record I got them another way

How did you get your POC NAT result?

What was the result of your POC NAT? >1000 copies RNA

< 1000 copies RNA Invalid

I don't remember

How acceptable was the way you got your POC NAT Very unacceptable result? Unacceptable

Slightly unacceptable Slightly acceptable Acceptable

Very acceptable

I trust the accuracy of the POC NAT result. Strongly disagree Disagree

Slightly disagree Slightly agree Agree

Strongly agree

My understanding of my POC NAT result from my research I am HIV positive

visit is that it showed: I have a high level of HIV in my blood

(Please choose the best answer) My viral load is below the cutoff for the test I am undetectable

I don't know Other

My understanding of my POC NAT result from my research visit is that it showed:

Now that you have received your POC NAT result, what Nothing will change

will you do with that information? (check all that I will start taking anti-HIV medications apply) (antiretroviral therapy, or ART)

I will work on taking my pills every day

I will see my primary care provider again sooner I will tell my partner/s my result

I will talk to my primary care provider about my result

My primary care provider and I plan to change my anti-HIV medications

My primary care provider and I already changed my anti-HIV medications

Other

Now that you have received your POC NAT result, what will you do with that information?

This is an acceptable test for I^Ht^Ih^Vi^.nk this test is effective in identifying HIV infection.

I would be willing to use this test again.

I did not like this test.

Overall, this test is more helpful than other tests for HIV.

I would recommend this test to others.

Strongly

disagree

Disagree Slightly

disagree

Slightly agree Agree Strongly

agree

My experience with the POC NAT was: Very negative Negative Slightly negative Slightly positive Positive

Very positive

How likely are you to share the result of your POC NAT with the people listed in the table below?
	Very unlikely	Unlikely	Somewhat Somewhat unlikely likely	Likely	Very likely	Not applicable

Your sex partner/s

Your needle-sharing partner/s Your friends

Your family

Your dating or hookup app profile/s

When do you usually get your viral load results? At my next visit I call the clinic

I look in my chart online I get them another way

When do you usually get your viral load results?

Are you currently on anti-HIV medications Yes

(antiretroviral therapy, or ART)? No

I don't know

The viral load cutoff level of this test is 1000 copies of viral HIV. This means that this test will be able to tell you if the amount of virus per milliliter of your blood is greater or less than 1000 copies of HIV. The test that you get in your clinic can tell you if your viral load is above or below a much lower level (often about 40-50 copies per milliliter of blood).

If your test said your viral load was below the cutoff Not confident at all level of 1000 copies per milliliter, how confident Not very confident

would you be that your anti-HIV medications are Somewhat confident

working? Very confident

At what viral load cutoff level would you feel No level - I will always worry about transmitting confident that your anti-HIV medications are working? HIV

Less than 40 copies Less than 200 copies Less than 1000 copies Less than 1500 copies Less than 5000 copies Other

I don't know

At what viral load cutoff level would you feel confident that your anti-HIV medications are working?

The viral load cutoff level of 1000 copies makes me Strongly disagree feel confident that I will not transmit HIV. Disagree

Slightly disagree Slightly agree Agree

Strongly agree

At what viral load cutoff level would you feel No level - I will always worry about transmitting

confident that you will not transmit HIV? HIV

Less than 40 copies Less than 200 copies Less than 1000 copies Less than 1500 copies Less than 5000 copies Other

I don't know

At what viral load cutoff level would you feel

confident that you will not transmit HIV?

Have you heard of HIV undetectable = untransmittable Yes (U=U)? No

Not sure

The next following set of questions will ask you about how you take your anti-HIV medications, called antiretroviral therapy or ART. We want to know a little bit about the anti-HIV medications you may be taking. If you are not able to recall an exact number or date when asked, it is okay to give an estimate.

How many pills have you missed in the last 4 days?

Please enter a number.

How many pills have you missed in the last 30 days?

Please enter a number.

When was the last time you missed a pill of your This week

anti-HIV medications (antiretroviral therapy or ART)? In the past month

1-3 months ago

More than 3 months ago Never

What was the reason you missed your pills the last Forgot

time you missed taking them? (check all that apply) Lost my medication

Was having side effects Was feeling depressed Didn't want to

Didn't want someone to see/know I was positive Ran out of medication

No reason Other

What was the reason you missed your pills the last

time you missed taking them?

Please rate your overall anti-HIV medications (antiretroviral therapy, or ART) adherence. 0% would mean that you never take your medicine, 50% means you take them about half the time, and 100% means you

never miss a pill. ^{0% 50% 100%}

(Place a mark on the scale above)

Your provider had a conversation with you about your anti-HIV medications (antiretroviral therapy, or ART) adherence at your visit. We would like to know how you feel about that conversation. Please rate how strongly you disagree or agree with each statement on the 6-point scale below.
	Strongly disagree	Disagree	Slightly disagree	Slightly agree	Agree	Strongly agree
The conversation was helpful to me.
My provider believed what I had to say.
I did not receive strategies to help me take my medications.
The conversation helped me to make changes to help me take my medications.
The conversation did not help me to understand how my medications work
During the conversation, we discussed other options for my medications.

Totally disagree Disagree Neutral Agree Totally agree

I doubt that my provider really cares about me as a person.

My provider is usually considerate of my needs and puts them first.

I trust my provider so much I always try to follow his/her advice.

If my provider tells me something is so, then it must be true.

I sometimes distrust my

provider's opinions and would like a second one.

^{I trust my provider's judgements} about my medical care.

I feel my provider does not do everything he/she should about my medical care.

I trust my provider to put my medical needs above all other considerations when treating my medical problems.

My provider is well qualified to manage (and diagnose and treat or make an appropriate referral) medical problems like mine.

^{I trust my provider to tell me if a} mistake was made about my

treatment.

I sometimes worry that my provider may not keep the information we discuss totally private.

You have reached the end of the survey. Thank you for your time!

Please check this box if you would like to receive a Send me my gift card, please!

$10 gift card.

We would also like to invite you to participate in an Yes, please contact me about the interview! interview to learn more about your experience in the

GAIN study. The conversation will take 45-60 minutes and you will be given a $40 gift card for your time.

Please check the box to let us know if you're interested and we will email you with more details!