Assessing Client Factors Associated with Detectable HIV Viral Loads; and Models of Care the Ryan White HIV/AIDS Program

RWHAP Viral Suppression Study – Client Interview

OMB Number: 0906-XXXX

Expiration Date: XX-XX-20XX

Public Burden Statement: 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.  The OMB control number for this project is 0906-XXXX.  Public reporting burden for this collection of information is estimated to average 30 minutes per interview. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857.

Attachment C: Ryan White HIV/AIDS Program Viral Suppression Study – Client Interview Guide

CONSENT CONFIRMATION

(see separate consent)

[Interviewer: ask interviewee if s/he needs to take a break before beginning the client interview]

Thank you for agreeing to continue talking with us today. Now we are going to start the interview part of this discussion, which will be more of conversation about some of the things we talked about earlier. As a reminder, we are interested in things that affect your ability to stay healthy. This includes things like your viral load test numbers that you may get from your doctor, health care coverage, access and use of health services, and stressful life events. We want to understand how these sorts of things might affect your your viral load numbers.. Sometimes I will use the term “viral suppression or virally suppressed.” By this, I mean having a viral load count below 200.

Remember, your answers in this discussion are confidential. You can skip any questions that you do not want to answer and you can end the interview at any time. This interview will be audio recorded for note-taking purposes but the recording can be turned off at any point you wish. `

1. HIV Medical Services

These questions will focus on HIV medical services. HIV medical services might include office visits for check-ups with your doctor (or other clinician e.g. nurse practitioner, physician assistant), receiving prescription medication, or lab tests like viral loads and CD4 tests.

1. Please tell me how long it has been since you were diagnosed with HIV.

2. How long have you been coming to this clinic?

3. Please describe the types of HIV medical services you regularly access here or elsewhere.

4. How often do you receive these services?

5. Which of these HIV medical services do you receive at this clinic?

6. Thinking about the last year, which HIV medical services do you feel were most important in helping you manage your HIV? Why?

Probe: How do these medical services affect your ability to maintain viral suppression?

7. Again thinking of the past year, what are some challenges you have faced getting HIV medical services? This can include services at this clinic or services you received before you started coming to this clinic. We are particularly interested in hearing about your experiences in the past year and how these barriers affect your ability to be virally suppressed..

Interviewer- refer to Question C1in client survey. If any responses rated 3 or above to responses “a through i”, please follow up with Question 7.a below:

7.a. You mentioned that in the past year you experienced [INSERT RESPONSE/S]. Could you describe how that/those experience(s) has impacted your ability and/or willingness to get HIV medical services?

Interviewer- refer to Question C2 in client survey. If “yes” to any responses “a through d”, please follow up with Question 7.b below:

7.b.You mentioned that since you have had HIV, you experienced [INSERT RESPONSE]. Could you describe how that experience has impacted your ability and/or willingness to access HIV medical services?

7.c. Have other things like housing, transportation, employment, or health care coverage impacted your ability to access HIV medical services? If so, how?

Probe: Of those you have discussed, which are the most critical or important in your ability to access HIV medical services?

7.d. Has alcohol or drug use (including non-medical use of prescription drugs) impacted your ability to access HIV medical services? If yes, please explain.

7.e. Have mental health challenges impacted your ability to access HIV medical services? If yes, please explain.

8. Have there been any programs or services that helped you become more engaged in care or return to care? If yes, please describe the program/service and how it helped you.

8. Do you think there are any specific things that a clinic can do to create an environment that helps you get and keep your viral load as low as possible? (Please provide examples.

Probe: appointment availability, separate clinic, separate space, clinic staff that are reflective of community, cultural competency (explain further), incentives, etc.)?

8. Do you think there are any specific things that your provider (physician, doctor, nurse) can do to help you get and keep your viral load as low as possible? Please provide examples.

2. HIV-related Pharmaceutical Services

Now we are going to discuss access to medications for HIV in the past year.

Interviewer- please check question one (1) regarding how long the respondent has been coming to this clinic, if less than one year then query after each question, “did you experience this in this clinic or the last clinic where you got care ?

11. Describe your experiences in getting your HIV medication. Consider challenges and/or helpful experiences.

Probes: consider problems getting prescriptions filled, changes to what your insurance or AIDS Drug Assistance Program (ADAP) would cover, specific medications, frequency of appointments or medication refills, etc.

11.a. [If problem was identified above:] How was the problem resolved or what solution helped?

11. Describe your experience with dosing and pill regimens for ART treatments. Consider challenges and/or helpful experiences.

Probes: consider factors such as pill size and frequency (e.g. daily or twice daily regimens), of medication, change of pill regimens due to side effects, etc.

11. What are some other challenges you have faced when accessing HIV medications?

Probes: consider cost/financing/insurance, confidentiality, availability; housing instability, stigma, substance use, mental health (please ask about specifics).

11. What are some things that make it easier to get HIV medications?

Probe: consider proximity/transportation, stable housing, financial aid, etc.

11. Over the past year, have you experienced any barriers to treatment adherence, or to taking your HIV medications as prescribed by your provider. If yes, please describe.

Interviewer- refer to Question C1in client survey. If any responses rated 3 or above to responses “a through i”, please follow up with Question 15.a below:

15.a. You mentioned that in the past year you experienced [INSERT RESPONSE]. Could you describe how that/those experience(s) has impacted your ability and/or willingness to adhere to HIV medication as prescribed by your provider?

Interviewer- refer to Question C2 in client survey. If “yes” to any responses “a through d”, please follow up with Question 15.b below:

15.b.You mentioned that since you have had HIV, you experienced [INSERT RESPONSE]. Could you describe how that experience has impacted your ability and/or willingness to adhere to HIV medication as prescribed by your provider?

15.c. Have any other things like housing, transportation, employment, and insurance coverage impacted your ability to adhere to HIV medication as prescribed by your provider? If yes, please describe.

Probe: Of those you have discussed, which are the most critical or important in your ability to adhere to HIV medication as prescribed by your provider?

15.d. Have other things like alcohol or substance use impacted your ability to adhere to HIV medication as prescribed by your provider? If yes, please describe.

15.e.Have other things like mental health impacted your ability to adhere to HIV medication as prescribed by your provider? If yes, please describe.

11. Can you tell me what things have helped with treatment adherence, or taking your HIV medications as prescribed by your provider.

16.a. Describe anything your provider or clinic staff have done that helped or supported your ability to take your HIV medication as prescribed by your doctor.

16.b. Describe anything your pharmacist has done that helped or supported your ability to take your HIV medication as prescribed by your doctor.

16.c. Describe any other things that helped or supported your ability to take your HIV medication as prescribed by your doctor that we have not discussed.

Probe: Could include social support systems or interpersonal relationships.

3. Non-HIV Medical Services

Next, we are going to discuss medical and other primary care services not necessarily related to HIV care, this could include things like mental health, substance use, hypertension, diabetes, hepatitis, or any other medical issues.

17. Describe the types of non-HIV medical services you regularly get at this clinic or elsewhere within the past year. Do you receive most of these services here?

17. Which non-HIV medical services do you feel are most important in helping manage your HIV? Why?

Probe: consider how other medical services affect the ability to achieve or maintain viral suppression?

17. Next, I am going to ask questions related to specific barriers or challenges that you may or may not have experienced in trying to access non-HIV medical care. We are particularly interested in learning how these barriers or challenges affect your ability to achieve and/or maintain viral suppression.

Interviewer- refer to Question C1in client survey. If any responses rated 3 or above to responses “a through i”, please follow up with Question 19.a below:

19.a. You mentioned that in the past year you experienced [INSERT RESPONSE]. Could you describe how that/those experience(s) has impacted your ability and/or willingness to access non-HIV medical care?

Interviewer- refer to Question C2 in client survey. If “yes” to any responses “a through d”, please follow up with Question 19.b below:

19.b. You mentioned that since you have had HIV, you experienced [INSERT RESPONSE]. Could you describe how that experience has impacted your ability and/or willingness to access non-HIV medical care?

19.c. How have other things like housing, transportation, employment, insurance coverage, or mental health and substance use impacted your ability to access non-HIV medical care?

17. Thinking about the barriers we just discussed, can you tell me about any services that might make it easier to access non-HIV medical care? We are particularly interested in learning how these affect your ability to achieve and/or maintain viral suppression.

20.a. Has your relationship with your provider or a staff person where you receive non-HIV medical services made it easier for you to access non-HIV medical service? If so, how?

20.b. Have there been other things that made it easier for you to access non-HIV medical services that we have not discussed? If so, what are they, and how did they make it easier?

17. Thinking of the past year, describe your experiences getting medication for non-HIV related health conditions.

Probes: consider problems getting prescriptions filled, issues with non-HIV related medication (e.g. medication interaction, prioritizing medication, total pill burden, etc.), changes to insurance.

4. Support Services

Now, let us talk about any of the services you receive that are not strictly medical services. This includes everything from case management and housing assistance to transportation, and food. It might alos include mental health or substance use services. I will refer to these services as “support services.”

22. What support services are you currently receiving?

22. What support services are you currently not receiving that would be helpful to you if you could have them?

22. Which support services do you feel are most important in helping people manage HIV?

Probe: explain how these services are important to managing your HIV… or give an example of a time when x service helped you better manage your HIV (e.g., through accessing HIV care, treatment adherence, etc.)?

22. What are some common challenges to accessing support services?

Probes: consider cost/financing/insurance, application process/getting into the system, confidentiality, availability, housing instability, stigma, mental health, substance use (please follow up with specifics).

22. What are some things that make it easier to access support services?

Probe: consider proximity/transportation, stable housing, financial aid, etc.

5. Closing

27. Are there any important points that you want to be sure we are aware of, that we did not talk about already?

Thank you for your participation, this information will be very helpful to HRSA.

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