SECTION A. INDIVIDUAL CHARACTERISTICS: DEMOGRAPHIC DATA	For Admin use only
Question 1. How old are you? (state age in years)………. years old Question 2. What is your marital status? 1) Married □ 2) Single □ Question 3. What is the level of your education? 1) Educated (Secondary/Tertiary/University) □ 2) Uneducated (Never been to school/Primary) □ Question 4. What is your religion? 1) Catholic □ 2) Protestant □ 3) Moslem □ 4) Other, specify □ Question 5. What do you do for your living? 1) Formally employed □ 2) Self-employed □ 3) Housewife □ Question 6. Does your occupation make you travel away from home/usual clinic? 1) Yes □ 2) No □ Question 7. If the answer to the above question is Yes, then how long are youaway from your home or usual clinic? 1) Several days □ 2) Several weeks □ 3) Several months □ Question 8. Looking at your care -card when were you supposed to come for your review …………………………………… Question 9. Would you mind sharing your reasons for missing your appointment …………………………………………………………. Question 10. Since you missed coming for your appointment at one time, tell me what happened for you to resume clinic visits again. 1) Reminded by a counsellor on phone. □ 2) Was discovered by a midwife during routine ANC /Postnatal check-up? □ 3) Came through as I became unwell. □ 4) I reported myself back as I realised that the baby could be infected if am not adhering to treatment. □ Question 11. Do you use traditional medicine for your HIV infection? 1) Yes □ 2) No □ Question 12. Do your religious beliefs deter you from taking conventional ARVs? 1) Yes □ 2) No □
SECTION B. INTERPERSONAL CHARACTERISTICS Question 13. Is your husband aware that you are HIV positive and you are taking ARV drugs for life? 1) Yes □ 2) No □ Question 14. Describe your current relationship with your partner/husband. 1) Physically and Psychologically aggressive □ 2) Non-aggressive, supportive and loving □
SECTION C. COMMUNITY PRACTICES Question 15. In the community where you stay, how do people feel about Pregnant or breastfeeding women taking ARVs for eMTCT? 1) ARVs do not prevent mother to child transmission of HIV □ 2) ARVs may prevent mother to child transmission of HIV □ Question 16. How do you feel about people knowing your HIV status? 1) Comfortable □ 2) Uncomfortable □ Question 17. Do you get affected negatively with what people from the community say about HIV positive clients? 1) Yes □ 2) No □ Question 18. Do you have people to remind you of the hospital schedule? 1) Yes □ 2) No □ Question 19. If yes then, what is the relationship with this person? 1) Spouse □ 2) Other family members □ 3) A friend □
SECTION D: SELECTED HEALTH-RELATED ATTRIBUTES Question 20. In this facility which health worker would you be comfortable to attend to you? 1) Midwives □ 2) Lay counsellors □ Question 21. Give the reasons for the answer above ---------------------------------------------------------------------------- ------------------------------------------------------------------------------ Question 22. In your perception how can you describe staff attitude towards expectant or breastfeeding women accessing care in this facility? 1) Accommodating □ 2) Cruel □ Question 23. Is there any privacy in this facility which can enable you to confide to any midwife or counsellor? 1) Yes □ 2) No □ Question 24. Where is adherence counselling provided from? 1) The open area in front of other clients □ 2) In an enclosed unit on one on one □ Question 25. How much time do you spend in this facility when you come for your appointment? 1) 1 hour □ 2) 3 hours □ 3) 5 hours □ Question 26. Do you receive sufficient information on the importance of good adherence concerningthe vertical transmission of HIV? 1) Yes □ 2) No □ Question 27. If you can make recommendations on adherence care through Test and Treat in this facility what would you want to be changed? -------------------------------------------------------------------------------- As we come to the end of this interview, I would like to thank you for your participation.