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Pre-Survey: Ending the Syndemic October 2023

Pre-Survey

We really appreciate you taking the time to take this survey.

1. Please enter your unique identifying number using your birth month (mm), last two numbers of your cell phone number, and the first letter of your middle name. If you do not have a middle name, please use the first initial of your last name. This number will be used to compare pre and post survey responses while keeping your responses anonymous.

Example: 0389S
Birth Month: March (03)
Phone Number: 012-345-6789
Middle Name: Smith *This question is required.

2. What is your clinical role?

3. What is the name of the clinic or organization in which you work?

4. Have you ever participated in an ECHO before?

5. Does your clinic/organization have a policy and/or protocol to address the following:

Space Cell	Yes	No
HIV Prevention	HIV Prevention: Yes	HIV Prevention: No
HIV Screening	HIV Screening: Yes	HIV Screening: No
HIV Treatment	HIV Treatment: Yes	HIV Treatment: No
Identifying who may benefit from PrEP	Identifying who may benefit from PrEP: Yes	Identifying who may benefit from PrEP: No
Prescribing PrEP	Prescribing PrEP: Yes	Prescribing PrEP: No
Syphilis Prevention	Syphilis Prevention: Yes	Syphilis Prevention: No
Syphilis Screening	Syphilis Screening: Yes	Syphilis Screening: No
Syphilis Treatment	Syphilis Treatment: Yes	Syphilis Treatment: No
Syphilis Standing Orders	Syphilis Standing Orders: Yes	Syphilis Standing Orders: No
Syphilis Field Based Treatment	Syphilis Field Based Treatment: Yes	Syphilis Field Based Treatment: No
Hepatitis C Prevention	Hepatitis C Prevention: Yes	Hepatitis C Prevention: No
Hepatitis C Screening	Hepatitis C Screening: Yes	Hepatitis C Screening: No
Hepatitis C Treatment	Hepatitis C Treatment: Yes	Hepatitis C Treatment: No
Substance Use Disorder Prevention	Substance Use Disorder Prevention: Yes	Substance Use Disorder Prevention: No
Substance Use Disorder Screening	Substance Use Disorder Screening: Yes	Substance Use Disorder Screening: No
Substance Use Disorder Treatment	Substance Use Disorder Treatment: Yes	Substance Use Disorder Treatment: No
Harm Reduction Services	Harm Reduction Services: Yes	Harm Reduction Services: No

6. Does your clinic/organization have specific programming (i.e. funding, clinics, physicians, etc.) for:

Space Cell	Yes	No
HIV	HIV: Yes	HIV: No
PrEP	PrEP: Yes	PrEP: No
Syphilis	Syphilis: Yes	Syphilis: No
Hepatitis C	Hepatitis C: Yes	Hepatitis C: No
Substance Use Disorders	Substance Use Disorders: Yes	Substance Use Disorders: No
Harm Reduction	Harm Reduction: Yes	Harm Reduction: No

7. In any given month, approximately how many patients do you estimate you are treating for....

HIV?
Syphilis?
Hepatitis C?
Substance Use Disorders?

9. Do you provide PEP (post-exposure prophylaxis for HIV) to...

Space Cell	Yes	No
Clinic staff with known exposure to HIV	Clinic staff with known exposure to HIV: Yes	Clinic staff with known exposure to HIV: No
People with known consensual contact with a person with HIV	People with known consensual contact with a person with HIV: Yes	People with known consensual contact with a person with HIV: No
Sexual assault survivors	Sexual assault survivors: Yes	Sexual assault survivors: No

10. Please rate your ability to manage the care of patients with HIV, Syphilis, HCV, SUD, and provide harm reduction in your own practice.

Very able	Able	Unable	Very unable
Very able	Able	Unable	Very unable

11. Please rate your likelihood of communicating with at least one professional outside your discipline, in order to support comprehensive care to patients with HIV, Syphilis, HCV, SUD, and harm reduction, within one month.

Very likely	Likely	Unlikely	Very unlikely
Very likely	Likely	Unlikely	Very unlikely

12. Please rate your knowledge of how to develop a program to address the syndemic in your community.The syndemic includes HIV, syphilis, hepatitis C, and substance use disorders.

Very good	Good	Poor	Very poor
Very good	Good	Poor	Very poor

13. Please rate your technical capacity (e.g. treatment capacity, laboratory personnel, clinical prioritization) to implement a program to address the syndemic in your community.The syndemic includes HIV, syphilis, hepatitis C, and substance use disorders.

Very capable	Somewhat capable	Somewhat incapable	Very incapable
Very capable	Somewhat capable	Somewhat incapable	Very incapable

14. Do you feel you have social support (e.g. trainings, clinical backing) for the work that you do?

15. Would you be interested in other trainings? Please select all that apply.

Information on HIV treatment
Harm Reduction
STIs
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.
Not applicable