| ANALYSIS OF SCREENING OF CONTACTS OF PEOPLE LIVING WITH HIV AT THE ANTIVENEREAL DISPENSARY OF THE NATIONAL INSTITUTE OF PUBLIC HYGIENE OF TREICHVILLE, ABIDJAN, COTE D’IVOIRE FROM JANUARY 2009 TO DECEMBER 2018 |
| QUESTIONNAIRE |
| Ms. or Mr., the Department of Public Health of the UFR of Medical Sciences of Abidjan is studying the problem of screening of contact subjects of people living with HIV that the country is facing. This study will make it possible to propose other strategies to raise awareness about testing at all levels of the health pyramid in order to achieve the 1st 90 of UNAIDS. This anonymous interview will take only 10 minutes of your time. Thank you for helping the scientific community to control the HIV/AIDS pandemic in Côte d’Ivoire. |
| 1) IDENTIFICATION OF THE INDEX CLIENT |
| Client code /__/__/__/ Age /__/__/__/ Sex: M ☐ F ☐ Number of sexual partners /__/__/__/ Number of children /__/__/__/ Education level ………………. Occupation ………………. Marital status ………………. Place of residence ………………. Is your partner aware of your HIV status? Yes ☐ No ☐ Have you invited your partner to get tested? Yes ☐ No ☐ |
| 2) IDENTIFICATION OF SEXUAL CONTACT |
| Type of sexual contact: sexual partner ☐ Offspring ☐ Client code /__/__/__/ Age /__/__/__/ Sex: M ☐ F ☐ Contact: ………………. District of residence: ………………. Education level: ………………. Occupation ………………. Nationality: ………………. Marital status: ………………. Number of children: /__/__/__/ |
| 3) SCREENING FOR SEXUAL CONTACT |
| a) DESCENDANT |
| Do you give your consent for the screening of your descendant? Yes ☐ No ☐ |
| b) SEXUAL PARTNER |
| Do you agree to be tested? Yes ☐ No ☐ If no, what are the reasons? Fear ☐ Discrimination ☐ Loss of trust in medical staff ☐ Other reasons:……………………………………………………… Was the screening test performed? Yes ☐ No ☐ If no, what were the reasons for not having the test done? Announcement of the serological status to the partner not made ☐ No acceptance of the test by the sexual partner ☐ Obstacles encountered by the contact ☐ Last of testing materials ☐ Other reasons:……………………………………………………… |
| 4) TEST RESULTS |
| Positive ☐ Négative ☐ If positive, what is the type of HIV? HIV 1 ☐ HIV 2 ☐ HIV 1/2 ☐ Undetermined ☐ |