Home-Based HIV Test Follow-Up QuestionnaireThank you for taking the time to answer questions about your experience with the HIV self-testing (HIVST) kit. The questionnaire will take about 5 minutes to complete. Please enable JavaScript in your browser to complete this form.1. Did you use the HIVST kit that was mailed to you? *YesNoSkip to question #4 if the response to #1 is 'Yes.'2. Why did you not use the HIVST kit?Unsure how to use itConcerned about confidentialityDid not want to know my HIV statusDid not have timeOther3. What did you do with the HIVST kit?It is at homeThrew it in the trashGave it to a friendGave it to a family memberOtherSkip to question #16 if you answered questions #2 and #3. 4. After receiving the HIVST kit, how many days did you wait to use it?None - I used it the day I received it1 to 3 days after receiving it4 to 7 days after receiving it8 days or more after receiving it5. Where did you use the HIVST kit?At homeAt workAt a friend's houseAt a family member's houseIn the carOther6. Did a testing counselor assist you with the HIVST process?YesNoSkip to question #8 if the response to #6 is 'No.'7. How helpful was the support you received from the testing counselor?Very helpfulHelpfulSomewhat helpfulNot helpful 8. How easy or difficult did you find it to use the HIVST kit?Very easyEasyNeither easy nor difficultDifficultVery difficult9. Was there a particular step that you found most challenging?Reading the instructionsRemoving the test tube capUsing the test stick Placing the stick in the tubeReading test resultsOtherNo challenges 10. How confident are you in your interpretation of the HIVST kit result?Very confidentConfident Somewhat confident Not so confident Not confident at all 11. Did you ask for help with interpreting the results?YesNo12. What was the result of your test?NegativePreliminary reaction (positive) Inconclusive 13. If your test results were preliminarily reactive (positive), did you get a confirmatory test?YesNoNot applicable 14. Did you tell anyone the results of your test?YesNoSkip to question #16 if the response to #14 is 'No.'15. With whom did you share your test results?Healthcare professional Staff member at AIDS ResourceStaff member at another social service agencyMental health counselorSpouse/PartnerFriend Family memberOther 16. How interested are you in using HIVST in the future?Very interestedInterestedUnsureNot interested Definitely not interested 17. How likely are you to recommend HIVST to a friend?Very likelyLikely UnsureNot likely Definitely not likely 18. How easy or difficult did you find it to request a HIVST kit?Very easy Easy Neither easy nor difficultDifficultVery difficult 19. Is this your first time getting tested for HIV? Yes No 20. How likely are you to access other services at AIDS Resource, such as sexually transmitted infection (STI) testing and free condoms?Very likely LikelyUnsureNot likelyDefinitely not likely21. How likely are you to refer someone to AIDS Resource in the future? Very likely Likely UnsureNot likely Definitely not likely22. Do you plan on talking with a healthcare provider about taking PrEP to prevent HIV? YesNo Submit
