Name of the interviewer:
Name of health facility:
• Assurance of confidentiality
1. Sociodemographic information on informant
c) Educational level (no education, primary, secondary, tertiary)
d) Who do you live with (spouse, children, house girl etc)?
e) Employment status (unemployed, self, government, NGO)
f) Distance from facility (in time or distance)
2. Whom did you consult/visit today? (can include more than one)
• Medical doctor
3. What was the reason for your visit today?
• To start using AIDS medicines
• Routine follow-up, if yes: when did you start using the AIDS medicines?
• Other reason
4. What was the result of the visit?
• I got AIDS medicines for the first time
• They gave me a refill of my medicines
• They gave me a different kind of medicine. If yes, why did the doctor prescribe different medicines?
• Other (describe)
5. If you were given AIDS medicines for the first time today, or were given a new kind of AIDS medicine today, what did the health worker tell you? (Open-ended, then probe on following topics)
• How ARVs work
• How to use them
• The need to continue treatment
• What to do if a pill is forgotten
• Possible interactions with other drugs
• Which side-effects can occur and what to do if they occur
• (Breast) feeding requirements
• When and where to get re-supply
6. (If client was given a repeat prescription, ask him/her the following; if not applicable, proceed to 8)
a) Did you talk with the health worker about your experience of using your medicines?
b) Did the health worker ask you if you have missed a dose? If yes, did the health worker explain what the effects are of missing a dose?
c) Did your health worker count your pills before giving you a new supply?
d) Did the health worker ask you if you were taking any other medicines?
7. Assessment of adherence and non-adherence
a) Do you have your medicines with you? May I see them? Please can you tell me when you take each of the medicines? (Refer to table with sun and moon, or other checklist)
b) Are there any other medications you are taking (e.g. septrin, herbs etc)
c) Over the last two days, when did you take your pills? (Not including today - from yesterday evening and back.)
d) Did you perhaps miss any? (Confirming (c), sympathetic manner. Details if yes.)
e) What do you use to remind yourself to take your pills?
8. Cost consideration
a) How much do you have to pay to cover your travel expenses when you visit the clinic?
b) What is the cost of registering at the clinic (if any)?
c) What is the cost of the ARV medicines that you take (if any)?
d) Do you lose any income as a result of your coming to the clinic?
e) Do you incur any other costs as a result of your taking ART?
f) Do you and your family have to give anything up in order to be able to pay for your ART?
9. Quality of care in the centre
I would like to ask you some more questions about the way you were treated in the centre today.
(a) What do you think of the service you receive at this clinic? (General, open- ended, and then prompt, as below: ask for details as necessary)
• Do you feel listened to?
• Are you given the chance to state your problems and ask questions?
• Are you treated with respect?
• Do you feel you can trust the health workers?
• Do you have privacy during consultation and counselling?
• How do you find the environment of the clinic?
(b) How long did you spend altogether at the clinic when you last came for review?
(c) How long did you have to wait before being attended to?
(d) Did you receive any written information?
10. Perceived problems and possible solutions
a) What do you perceive as most problematic regarding taking the ARV treatment?
b) What do you think could be done to improve this?
Have you any questions for me?
Thank you for your time and cooperation!