KEY INFORMANT INTERVIEW GUIDE
ASSESSMENT FOR HIV RAPID TEST TRAINING
Unique ID
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Birth Mo.
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Birth Day
Last 4 digits SSN
Building an effective HIV clinic response involves coordinating functions across multiple systems and disciplines in order to provide
comprehensive care and services to people with HIV or AIDS. This includes understanding your system of care such as structure, internal
and external resources, staffing and referral patterns. This assessment will help you describe your existing health care system and
contribute towards planning for education and training that best meet your needs as you engage in building or strengthening your capacity
to serve HIV-infected people in your community.
Interviewer Initials: ______
Contact Name:
Date:
Professional Role:
Clinic Name:
Address:
Telephone Number:
Fax:
E-mail:
HEALTH CARE SERVICES, STAFFING, FINANCING, AND GENERAL PATIENT POPULATION
1.
What types of services do you have at your clinic site/practice setting/agency?
[01] Primary Health Care
[02] Mental Health Care
[03] Alcohol/Substance Abuse Treatment
[04] Pharmacy Services
[05] Family Planning Services
[06] Dental Care
[07] Patient Education
[08] HIV/AIDS Care and Treatment
[09] Case Management
2.
What types and numbers of providers do you have at this clinic/agency?
[01] ___ Physician
[02] ___ Physician Assistant
[03] ___ Nurse Practitioner
[04] ___ Registered Nurse
[05] ___ Licensed Practical Nurse
[06] ___ Phlebotomist/Lab Technician
[07] ___ Nurse Aide/Medical Assistant
[08] ___ Community Health Aid/Worker
[09] ___ Pharmacist
[10] ___ Dentist
[11] ___ Dental Assistant/Hygienist
[12] ___ Nutritionist/Dietician
[13] ___ Social Worker
3.
[14] ___ Case Manager/Outreach worker
[15] ___ Mental Health Counselor
[16] ___ Substance Abuse Counselor
[17] ___ Health Educator
[18] ___ Prevention Specialist
[19] ___ Family Planning Specialist
[20] ___ Midwife
[21] ___ Traditional/Alternative Practitioner
[22] ___ Radiologist/x-ray technician
[23] ___ Spiritualist
[88] Other (identify) _________________
Volunteers______
How would you describe your overall staffing level?
Very well staffed
4.
[10] HIV Case Management
[11] Maternal/Child Health Care
[12] Obstetrics and Gynecology
[13] Midwifery
[14] Laboratory
[15] Radiology
[16] Alternative Medicine
[17] Traditional/Spiritual Healing
[88] Other (identify) __________
Adequately staffed
Understaffed
How much staff turnover do you experience?
Developed by NW AETC for HRSA Grant 05-044 at University of Washington, Seattle, WA (June 2005)
High turnover
Moderate turnover
Low turnover
What area is turnover highest? _______________
5.
What populations do you serve? __________________________________ Any minority populations? (if so, % and identify, please)
6.
Are you presently conducting sexual history-taking and/or risk assessments with your patients? _______ How often?________
Do you have 24 hr. on-call or emergency staffing for:
Medical care:
Yes
No
If YES, who provides this service? _____________
Counseling services:
Yes
No
If YES, who provides this service? _____________
7.
Do you have an on-site laboratory for running blood tests?
Yes
8.
Do you presently conduct HIV testing/screening on site?
Yes
No
No
Don’t know
If YES, how many tests have you conducted WITHIN THE PAST THREE MONTHS?
9.
What types of HIV tests do you conduct (check all that apply):
ELISA (Blood test -- enzyme-linked immunoassay)
Western Blot (Blood test)
Oral Specimen Collection (OraSure®)
Urine HIV-I Testing (Urine EIA and Western Blot)
10. If you do not presently provide HIV tests, have you selected the type of rapid test you plan to use?
Oraquick Advance _________
Clearview ___________
Unigold ____________
Please briefly describe why you selected
this waived test and how you see it fitting into your present “flow” of patient/client care:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
11. Please describe the systems you have in place to provide waived rapid testing:
Quality Assurance protocols
Staff trained in finger-stick blood collection
QA Staff person to monitor test kits, run controls, data entry, log
Confidentiality policies
records, assure compliance of other staff
Identified staff who will conduct rapid testing
Staff trained in HIPAA
Counseling training for those staff members (i.e. RESPECT course)
CLIA waiver completed, submitted, approved
Waived testing policies currently in place
If preferred rapid test has been selected, has staff been trained in manufacturer’s guidelines?
By whom _______________________
Staff trained in delivering waived rapid test results
Staff trained in universal precautions
Does your clinic/agency plan on providing off-site or mobile rapid-testing?
12. Do you receive federal/state funding?
Yes
No
We have certain funding constraints when working with another agency that also receives federal/state funds. Please describe your funding
sources:
If receiving state rapid test kits and/or funding, has your staff been trained in state law (if applicable) regarding waived testing and has your staff
been trained in the use of required forms/data collection? (please
explain)________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
13. If a client tests reactive in your clinic/agency using the waived rapid test, what will be your protocol for getting that person
confirmatory testing and/or into HIV-specific medical care/services?
14. What do you see as your staff’s primary educational needs to prepare them to conduct waived rapid testing?
15. Do you anticipate the need for an on-site observation/assessment of your site conducting the waived test?
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