NIGERIA PrEP DEMONSTRATION STUDY
Risk Taking Behaviours 2 HIV Negative
Screening ID:Site Study Screening Number / Participant ID:
Site Study Couple I/P Chk / Visit Date:
dd mm yy
1 / Imagine I have 10 balls, one of which is red and nine of which are black. If you pick one of these balls without looking, how likely it is that you will pick the red ball? Question to the interviewer: did the respondent said 1 chance out of 10, 10%?
Circle the correct answer / Yes / No
2 / I will ask you several questions about the chance that certain events are going to happen. I would like you to use this scale that goes from 0 to 100 to indicate the chance that the event occurs. If you chose 0, this means that you are sure that the event will not occur. The higher the number you chose is, the more likely is the event to happen. For example if you answer 50, it means that it is just as likely that the event happens as it does not happen (fifty-fifty). If you indicate a number below 50 it means that the event has more chances to not happen than to happen. If you indicate a number greater than 50 it means that the event has more chances to happen than to not happen. If you answer 100, it means you are certain that the event will occur.
Answer
a / What is the likelihood that your partner is infected with HIV according to you?
b / What is the likelihood that you are infected with HIV according to you?
c / What is the likelihood that you use a condom with your partner during the next sexual intercourse?
d / What is the probability that you will use a condom for each TEN of the next sexual intercourses with your partner?
e / What is the probability that you accept to take PrEP?
f / What is your probability that you take PrEP consistently i.e. everyday?
g / What is the probability that you will experience side effects while on PrEP?
h / What is the probability that you will take PrEP consistently if you experience any mild side effects occur?
i / If you do not use PrEP consistently, what is the likelihood that you get infected with HIV in the next year according to you?
j / If you use PrEP consistently, what is the likelihood that you get infected with HIV in the next year according to you?
k / What is the probability that you will use condom in the next 10 sexual intercourses with your infected partner if you take PrEP?
l / What is the probability that you become HIV positive in the next 12 months if your partner consistently use ART?
m / If you have one unprotected sexual act with your HIV positive partner, what is the probability that you become infected with HIV as a result?
n / If you have one protected sexual act with your HIV positive partner, what is the probability that you become infected with HIV as a result?
VISIT MONTH
Completed by: (initials/date) ______
Forms Instruction
The Risk taking behaviours 2 CRF is completed at Enrollment and annually (Months 12 and 24) by both the PrEP user AND the partner, use the correct form depending on the HIV status of the respondent. The same form is used for male and female partner participants.
Item1 / This question measures the knowledge of probabilities of the respondent. Circle “yes” only if the respondent has responded correctly i.e. that the respondent has given the following answer:1 chance out of 10 or 10 chances out of 100 or10%If the respondent responded incorrectly, did not know or did not respond circle “no”.
Items 2 / These questions are directly asked to the respondent.
Please present the scale to the respondent and ask them to indicate the likelihood that the event will occur on the scale.