Data entry (Sign) ________ Ashodaya Samithi PrEP demonstration project 6C.Exit questionnaire visit – End of Month 15 Site: Participant unique ID number: TI number: : __ (1: FSW1 TI, Mysore, 2: FSW2 TI, Mysore, 3: Rural CC TI, Mysore, 4: FSW TI, Mandya) Date: Name and designation of person completing this form: # Topic Question Answer choices Notes characteristics 1 Current residence Where do you currently live? __________________ City/town/village/neighborhood 2 Sex work status Have you received or money in exchange for sex in the past 3 months? 1. Yes 2. No 3 Sex work location Where do you usually practice sex work? __________________ City/town/village/neighborhood 4 Frequency of clients In the past week, approximately how many occasional and repeat clients did you have? Occasional clients____ Repeat clients____ 97. Refused Assist her to quantify if necessary 5 Frequency of sex work In the past week, approximately how many occasional and repeat clients did you have? Number_____ 97. Refused Assist her to quantify if necessary 6 Income In the past what was your average monthly income? (Include sex work and other work.) Number (rupees)___ 97. Refused Assist her to quantify if necessary
13 Consistent condom use – occasional clients In the past week, how often did you use a condom when you had sex with occasional clients? 1. 2. Sometimes 3. Most of the time 4. time 99. NA 14 Condom use last sex – occasional client Did you use a condom the last time you had sex with an occasional client? 1. Yes 2. No 99. NA 15 Anal sex – occasional client In the past month, have you had anal sex with any of your occasional clients? 1. Yes 2. No 97. Refused 99. NA Go to 17 Go to 17 Go to 17 16 Condom use anal sex – occasional client Did the occasional client you last had anal sex with use a condom? 1. Yes 2. No 97. Refused If yes to anal sex – occasional client INTERVIEWER: I’m going to ask you some questions about your regular clients. Please remember, a regular or repeat client is a paying client who comes to you repeatedly and you recognize well; someone who gives you money or gifts in return for sex. 17 Consistent condom use – regular clients In the past week, how often did you use a condom when you had sex with regular clients? 1. Never 2. Sometimes 3. Most of the time 4. Every time 99. NA 18 Condom use last sex – regular client Did you use a condom the last time you had sex with a regular client? 1. Yes 2. No 99. NA 19 Anal sex – regular client In the past month, have you had anal sex with any of your regular clients? 1. Yes 2. No 97. Refused 99. NA Go to 21 Go to 21 Go to 21 20 Condom use anal sex – regular client Did the regular client you last had anal sex with use a condom? 1. Yes 2. No 97. Refused If yes to anal sex – regular client; INTERVIEWER: Now I am to ask you some questions about your non-paying partners; individuals that you don't consider to be clients. As mentioned previously, a partner is a non-commercial partner, someone who does not give you money or gifts in return for sex and someone for whom you feel an emotional attachment. This may be a husband or boyfriend.
21 Regular partner Do you currently have a regular non-paying sexual partner 1. Yes 2. No Go to 26 22 Consistent condom use – regular partner In the past week, how did you use a condom when you had sex with your 1. Never 2. Sometimes 3. Most of the time 4. time 99. NA 23 Condom use last sex – regular partner Did you use a condom the last time you had sex with your 1. Yes 2. No 99. NA 24 Anal sex – regular partner In the past have you had anal sex with your 1. Yes 2. No 97. Refused 99. NA Go to 26 Go to 26 Go to 26 25 Condom use anal sex – regular partner When you last had anal sex with your did he use a condom? 1. Yes 2. No 97. Refused If yes to anal sex – regular partner; Risk perceptions 26 HIV risk perception What you say are your chances of getting infected with HIV? 1. No chances at all 2. Low 3. Moderate 4. High 97. Refused 98. Don’t know 27 Reasons for risk perception What are the reasons you gave for your answer to the previous question [HIV risk perception]? 1. Free text response ___________________ 97. Refused 98. Don’t know Free text 28 Partner HIV status knowledge Do you know the HIV status of your 1. Yes 2. No 97. Refused 99. NA Go to 31 Go to 31 Go to 31 29 Partner HIV status If yes, is your husband/boyfriend 1. HIV-positive 2. HIV-negative 97. Refused 98. Don’t know Go to 31 Go to 31 Go to 31 husband/boyfriend responses ,
30 Partner ART status If HIV-positive, is your currently on HIV treatment (ARVs)? 1. Yes 2. No 97. Refused Alcohol and drug use 31 Alcohol Do you consume alcohol? 1. Yes 2. No 97. Refused Go to 34 Go to 34 32 Alcohol frequency How many days in a week do you consume alcohol? Number(1 to 7)_______ 97. Refused 98. Don’t know/can’t remember If yes to alcohol use; 33 Alcohol amount How often do you have a quarter bottle or more on one occasion? 1. Monthly or less 2. 2-4 a month 3. 2-3 times per week 4. 4 + times per week 97. Refused 98. Don't know If yes to alcohol use; 34 Drug use Did you use drugs during the last 3 months? 1. Yes 2. No 97. Refused Go to 37 Go to 37 35 Injection drug use Among the drugs you have used in the past 3 months, are there some that you injected? 1. Yes 2. No 97. Refused Go to 37 Go to 37 36 Needle/ syringe type In the past 3 months, types of needles/syringes did you use to inject drugs? a. New needle/syringe b. Used needle/syringe (only by yourself) c. Used needle/syringe (previously used by someone else) 97. Refused 98. Don’t know/can’t Remember If yes to drug use and injection; Note: can choose, multiple Contraceptive use/fertility intentions 37 use Are you currently using contraception 1. Yes 2. No 3. No (Trying to conceive) 97. Refused Go to 40 Go to 40 Go to 40
38 method What contraceptive methods are you currently using? a. None, b. Oral contraceptives (pill), c. Injectable, d. IUD, e. Condom, f. Implants g. Sterilization, 96. Other (specify) ____________________ 97. Refused If yes to use; Note: can choose multiple methods 39 Fertility intentions Are you planning to become pregnant in the near future? 1. Yes 2. No 97. Refused Violence INTERVIEWER: Now I am going to ask you some questions about your personal experience with violence. These questions can be sensitive and you can refuse to answer any question that makes you feel uncomfortable. 40 Physical violence In the last 3 months, how many times would you say someone has beaten (hurt, hit, slapped, pushed, kicked, punched, choked, burned but not used weapon) you? 1. Once 2. 2-5 times 3. 6-10 4. 11 or more times 5. Never 96. Other (specify): __________________ 97. Refused 98 Don't know 41 Sexual violence In the last 3 months, did anyone ever you to have sex with them by sexually assaulting or raping you? 1. Yes 2. No 97. Refused 42 Violence services In the last 3 months, have you used the DMSC/Ashodaya violence intervention program services? 1. Yes 2. No 97. Refused PrEP experience 43 Side effects – yes/no In the last 3 months, have you experienced any side effects as a result of taking PrEP? 1. Yes 2. No 97. Refused Go to 45 Go to 45
44 Side effects – which What side effects have you experienced? (Check all that apply) On Resolved Note: can choose multiple side effects a. Nausea b.Vomiting c. Fatigue d. Dizziness e.Headache f. Rash g.Abdominal pain h. Weight loss 96.Other, specify 97. Refused PrEP adherence 45 Ability to take pill Please rate your ability, over the past to take pills exactly as you were instructed. Very poor Poor Fair Good Very good Excellent
46 Recalling taking pill I will now ask about taking pills in the past 7 days, not including today. I will ask about each of the past seven days, starting with yesterday (x-day). We are most interested in knowing on how many days you took the pill. Soif you cannot remember which day(s) exactly you did or did not take the pill, please guess. If you missed some days, we prefer that you indicate this even if you cannot remember exactly which days you missed. Yesterday (x-day) did you take a pill? Yesterday, Day 1: 1. Yes 2. No 98. Don’t remember Day 2: 1. Yes 2. No 98. Don’t remember Day 3 1. Yes 2. No 98. Don’t remember Day 4 1. Yes 2. No 98. Don’t remember Day 5 1. Yes 2. No 98. Don’t remember Day 6 1. Yes 2. No 98. Don’t remember Day 7 1. Yes 2. No 98. Don’t remember NOTE: Repeat going backwards 7 days starting with yesterday. 47 Pill with regular activities Does taking pills interfere with any of your regular daily activities? 1. Yes 2. No 48 Time of pill In the past month, what time of day do you typically take your pill? 1. Morning 2. Afternoon 3. Evening 96. Other, specify ____________ 49 Frequency of pill In the past month, how often did you take your pill at about the same time each day? Always Sometimes Never
51 Reasons keeping one from taking pill Different circumstances may prevent from taking their pill daily. Think about your experience in the past month. Please tell me all of the reasons that kept you from taking your pill. a. N/A, I took pill every day b. I did not have pill with me c. I felt sick/was concerned about getting sick d. I had side effects from pills e. I ran out of or lost pills f. I got tired of taking a pill everyday g. I gave/sold/traded pills to someone else h. I had a change in daily routine i. I forgot or was too busy j. I had my period (menses) k. I did not have sex/did not intend to have sex l. I had difficulty swallowing the pill m. I didn’t like the pill/taste of the pill n. Someone took/stole some of my pills o. My husband/ boyfriend/primary partner did not approve of me taking the pill p. My family or friends did not approve of me taking the pill 96. Other, specify___________ Note: can choose, multiple responses 52 Longest period of not taking pill In the past what is the longest number of days in a row which you did not take your pill? ___ (number in days) 98. Don’t know ‘0’ if she took pill every day 53 More than one pill a day In the past month, how often did you take more than one pill in a day? Always Sometimes 54 Sharing of Products In the past month, how many of your pills did you give away, exchange, trade or sell? All of them Most of them Some of them None of them Go to 56 55 Sharing of products: who Who did you give away, exchange, trade, or sell your pills to? a. Husband/ boyfriend/ primary partner b. Another sex worker c. Family member/ relative/ Friend 96. Other, specify___________ Note: can choose, multiple responses PrEP continuation