Q ID
Questions
Responses
Skip Pattern
A
PARTICIPANT INFORMATION
001
Participant Unique ID
002
Date of Informed Consent
D D M M Y Y Y Y
/
/
003
Age at last birthday (years)
004
Which category best describes your age at last birthday?
<20 21 - 25 26 - 30 31 - 35 36 - 40 41 - 45 >46
005
Which of these religious group do you most identify with?
Islam Christianity Other (Specify)………...…
006
Employment:
Not Working (Support from Someone Else)
Pupil/Student (Support from Someone Else)
Employed Retired
Other (Specify)………………...…
007
If employed, what is your occupation?
Professional Self-employed business man/woman
Entertainment/Service/Bar/Restaurant/Hotel
Driver/Labourer Uniformed armed service
Other (Specify)………...…
Skip if a or b to Q006
008
Relationship Status:
Married Single (Never Married) Divorced Separated Cohabiting Widow
Other (specify)………………………...
009
How Long Have You Been in your current Relationship? (Years)
0 - 4 5 - 9 10 - 14 >=15
Skip if b to Q008
010
How Many Children Do You Have?
0 1 - 2 3 - 4 >=5
011
How Many Pregnancies did you Have Before Discovering your Positive Status?
B
Study Outcome—Disclosure Status and MTCT experience
101
Have you disclosed your HIV status to your intimate partner?
Yes No
102
Do you know your partner HIV status
Yes No
103
If yes, what is your intimate partner's HIV status?
Positive
Negative
Skip if Q102 is No
104
Is your partner currently on ART?
Yes No Don’t Know
Skip if Q103 is Negative
105
Do you need authorisation from your partner to go to the hospital for PMTCT services?
Yes No
106
Do you have any biological children with positive HIV status?
Yes No
107
How many of your children are HIV positive?
______________Type in.
Skip if Q106 is no
C
Participant’s HIV/PMTCT Care History
201
Date of HIV diagnosis (Confirmation).
Hint: Type 9999 if don’t know
D D M M Y Y Y Y
/
/
202
Date of ART Initiation
Hint: Type 9999 if don’t know, or 8888 if not on ART
D D M M Y Y Y Y
/
/
203
Where you newly diagnosed of HIV in this current pregnancy or you are an existing ART client?
Newly diagnosed in this pregnancy, but yet to be initiated on ART
Newly diagnosed and initiated on ART in this pregnancy
Previously diagnosed of HIV prior to this pregnancy, however I was newly initiated on ART in this pregnancy
I have been diagnosed of HIV and initiated on ART prior to this pregnancy
204
Duration on ART (In Years)
Enter “0” if less than 1 year
__________________________
205
Duration on ART (In Months)
____________________________
Skip if Q204 ≥ 1
206
At what pregnancy month did you register for ANC/PMTCT care in this current pregnancy?
Enter 99 if don’t know
____________________________
207
What is gestational age today? (In Month)
____________________________
208
Did you receive HIV counselling and testing in this pregnancy?
Yes, counselling only (for known positive clients)
Yes, I received HIV counselling and testing
Yes, counselling only (for known positive clients)
No
209
What type of pre-test counselling did you receive?
Individual Counselling
Group Counselling
Skip if Q208 is no.
210
Did you receive a follow-up counselling?
Yes No
211
Before commencing PMTCT, was adherence counselling done?
Yes No
212
Have you ever missed taking your medicines in the past month?
Yes No
213
Reasons for the missed medication?
Religious reasons
Too busy to pick up drugs
Forget to take medicine
Felt better
Felt overwhelmed and depressed
Other reasons (Specify___________)
214
Date of last viral load testing
Enter 9999 if can’t remember/ don’t know.
D D M M Y Y Y Y
/
/
215
What is the viral load count?
________________________________
D
Knowledge and Perception of HIV/AIDS and PMTCT
301
Where did you first hear about PMTCT from? (Select one only)
Family/Friends Healthcare Workers
Mass Media (Radio, Television)
Social Media (WhatsApp, Instagram, Facebook)
Other (Specify)………….…
302
Do you think every pregnant woman should be tested for HIV?
Yes No Maybe
303
In what ways do you think HIV can be transmitted from mother to child? (Tick all that apply)
HIV can be transmitted during pregnancy
HIV can be transmitted during delivery
HIV can be transmitted during breastfeeding
Don’t know
304
How do you think HIV transmission from mother to child can be prevented?
Antiretroviral therapy before pregnancy (when status was confirmed)
Antiretroviral therapy during pregnancy
Delivering by caesarean section
Giving antiretroviral drugs to the new-born
Don’t know
305
Do you know the main test done to check if your treatment is working? (Tick all that apply)
CD4 Testing Repeat HIV Testing Viral Load Testing
Don’t know
306
Do you think it is advisable for a HIV-positive woman to breastfeed?
Yes No Don’t Know
307
If yes, what is your reason for selecting Yes?
Women can breastfeed only if they are virally suppressed.
Women can breastfeed if they are not virally suppressed.
Women can breastfeed only if it is exclusive breastfeeding and they are virally suppressed.
Don’t know
Skip if Q306 is No or Don’t know
End of Interview. Thanks for your time.