Gwadz Qualitative Interview Guide (Revised April 27, 2020)

PLEASE AUDIO-RECORD

NOTE TO INTERVIEWER:

In this part of the interview you will explore the effects of COVID with participants. Please try to elicit their experiences and thoughts on these effects. We want to know how COVID is affecting participants, including the deeper structural and social underlying factors. You can explore aspects of COVID that are not directly addressed in these questions. You do not need to ask all of these questions as they are written. The main idea is to capture the participant’s experiences and thinking about COVID. We are interested in individual and community resilience, and also how we can prepare better in the future for crisis events such as these.

Be sure to ask Qs 14-18.

NOTE: THERE ARE RESOURCES AND GUIDELINES FOR PLWH AT THE END OF THIS DOCUMENT, INCLUDING A REFERRAL NUMBER FOR FREE MENTAL HEALTH CARE. PLEASE REVIEW.

NOTE: PARTICIPANTS MAY BE EXPERIENCING LOSS AND GRIEF DURING THIS PERIOD. PLEASE MAKE REFERRALS AND OFFER SUPPORT AT THE END OF THE INTERVIEW AS APPROPRIATE.

Note: You can remind participants that we are going to ask about some sensitive topics, but we ask every participant all of these questions. They can decline to answer any question we ask. And we appreciate their honesty.

 

DOMAIN

PROBES

1.

What have you heard about

What have you heard about the new corona virus, also called COVID-19 or SARS-CoV-2?

Who or where do you get your information from?

What do you think about the accuracy of what you have heard?  (PROBE FOR COUNTER-NARRATIVES, SOURCES OF INFORMATION, ETC)

What sources of information do you trust?

Do you think you are well-informed about corona virus, or would you like to know more?

(IF HAS NOT HEARD MUCH) Why do you think you have not heard too much about the new corona virus?

1.5

PLWH

Do you think people living with HIV are more at risk or less at risk for the new corona virus than people not living with HIV? (EXPLAIN)

2

COVID sx

Have you shown symptoms of the new corona virus?

Common symptoms include:

·        fever

·        tiredness

·        dry cough

Some people may experience:

·        aches and pains

·        nasal congestion

·        runny nose

·        sore throat

·        diarrhea

IF YES, When was that? (DESCRIBE)

Did your friends or family get or possibly get the corona virus?  (EXPLORE)

2.2

COVID testing

Did you try to get a test for corona virus?  (IF YES, EXPLORE WHAT HAPPENED)

Were you able to get a test? Why or why not?  (EXPLORE)

2.3

COVID dx and treatments

Have you been diagnosed with the new corona virus?  OR Do you think you probably had the new corona virus or have it now?

(IF YES) Have you tried to receive any treatments for the new corona virus? What happened?  (EXPLORE. IF APPROPRIATE, ASK PARTICIPANT WHY THINGS HAPPENED THE WAY THEY HAPPENED)

3

Social distancing, change in movements

Did you or have you changed how much you stay home or who you interact with as a result of the new corona virus?

(IF YES) How did you/have you changed? How was that/has that been for you? (DESCRIBE)

(IF NO) Have you heard any recommendations about staying at some, or “social distancing”?  What do you think about those recommendations?

NOTE AS OF APRIL 20th: A stay-at-home order was issued by the NYS Governor on March 20, 2020. Initially it was to be in effect until April 29th, but then was extended until May 15th.

4

 Phone/internet issues and access

Some providers are conducting sessions over the phone or virtually.

What kind of phone do you have, if any?

Do you have enough minutes in your phone plan to speak to a provider at length?

Does your phone allow for video conferencing using something like Skype or Zoom?  Have you heard of that and do you know how to do that?

Do you feel a different type of phone or phone plan would help you in times when normal life is disrupted, such as today?

Have you had any health care appointments over the phone?  How was that for you?

5

 Concern

How concerned are you about your getting (that is, contracting) the new corona virus? (DESCRIBE)

Why or why not?

Did your concern change over time?  Why or why not?

6

Guidance

Have you received and/or asked for any guidance from any of your health care providers about the new corona virus? Did you get enough information?  Why or why not?

Have you received or asked for general information about keeping yourself safe?  (NOTE: PROVIDE INFO ON SAFETY PRECAUTIONS AT THE END OF THE INTERVIEW AS NEEDED)

Have you received or asked for information about your specific individual issues related to your current medical status and the new corona virus?

6.5

Spirituality and faith

Have you drawn on your faith or spirituality during the corona virus pandemic? (DESCRIBE)

Have you been able to access your faith community?  Why or why not? (EXPLORE)

7

Effects on desire and/or ability to access HIV care and other types of health care

Has the new corona virus affected your desire or ability to access HIV health care?  (DESCRIBE. CAN INCLUDE BARRIERS AT THE CARE SITE SUCH AS SHORTER HOURS OR CLOSED FACILITIES.)

Has it affected your desire or ability to access other types of health care, including health care for conditions other than HIV?

Mental health care?

8

Effects on desire and/or ability to access support or treatment for substance use

Has the new corona virus affected your desire or ability to access treatment or support for substance use, including alcohol and tobacco?  (DESCRIBE)

PROBES INCLUDE

·        AA or NA

·        Methadone maintenance treatment programs

9

Effects on substance use patterns including tobacco use

Has the new corona virus affected your substance use patterns or thoughts about substance use, including alcohol, marijuana, other drugs, and tobacco?  (DESCRIBE AND ASK ABOUT WHAT SPECIFIC DRUGS ARE USED, NOT JUST SUBSTANCE USE AS A WHOLE. THERE MAY BE DIFFERENT ISSUES WITH DIFFERENT SUBSTANCES)

PROBES INCLUDE

·        Using more/want to use more

·        Use less/want to use less

·        Issues with access to substances

·        Issues with selling substances to others

·        Change the type of substance used

·        Isolation as a trigger

·        Boredom as a trigger

10

Effects on desire to take or adhere to HIV medications, or access HIV medications

Has the new corona virus affected your desire to take HIV medication or adhere to HIV medication?  How has it affected your desire to take HIV medication (DESCRIBE)

Why do you think your desire to take HIV medication or adhere to HIV medication has changed?

Has the corona virus affected your ability to get access to HIV medication when you wanted it?  (DESCRIBE)

11

ART habits

Has the new corona virus affected any of the habits you have developed to take HIV medication, either in positive ways or negative ways?  (DESCRIBE)

12

Mental health and coping, relationships

Has the corona affected your quality of life and/or mental state? (DESCRIBE)

PROBES INCLUDE

·        Are you more or less socially connected?

·        Are you more or less engaged in activities?

·        Are you more or less feeling bored?

How do these experiences or feelings affect your ability to manage your mental health?

How has the corona virus and/or social distancing affected your relationships, either in positive or negative ways?

Sexual behavior, sexual health, relationships

What strategies do you use to cope during the corona virus outbreak?

12.5

Informal economy and street economy

The corona virus has caused a shift in how people make money and meet their basic needs.

This includes activities such as panhandling, working at bodegas, selling drugs, and exchanging sex for food, money, drugs, or a place to stay.

Has the new corona virus affected any of the ways you usually get what you need to take care of yourself? (DESCRIBE)

Or have you heard from others how they have been affected? (DESCRIBE)

13

Access to food or other resources, basic needs

Has the new corona virus affected your access to food or other resources you need? (DESCRIBE)

Have you had any problems with finances, housing, work, etc.?

13.5

White, SES

Do you think people of color are more at risk or less at risk for the new corona virus than White people? (EXPLAIN)

Do you think people with limited means are more at risk or less at risk for the new corona virus than people with high income, resources, and means? (EXPLAIN)

(NOTE: This question is presented late in the guide to see if issues of racial/ethnic disparities and SES disparities emerge organically. This question can be skipped if already addressed.)

14

Vax

We know some people have mixed feelings about vaccines. I want to ask you about that.

A new flu vaccine is available every year. Do you usually get the flu vaccine?  Why or why not?

If there was a vaccine for the corona virus, would you get it?  Why or why not?

15

“Indigenous coping strategies”

Can you think of ways that you, or others in the community have come up with creative ways to manage in the time of the corona virus?

PROBES FOR DOMAINS TO EXPLORE

·        employment/making a living

·        getting prescriptions filled

·        physical health

·        mental health

·        social distancing (DEFINE IF NECESSARY)

·        tobacco use

·        social needs

·        substance use treatment

·        getting access to substances (alcohol, marijuana, etc)

·        housing

·        material needs such as food

·        keep phones on

·        anything else?

16

Needs, unmet needs

What do you and members of your community need to manage life during the corona virus outbreak that you are not getting?

PROBES

·        access to houses of worship

·        type/quality of housing

·        internet access

·        phone minutes

·        type of phone

·        a regular supply of food

·        social support and social connection

·        food delivery service

·        access to corona virus testing

17

Any other effects - HIV

Is there anything else we should know about how the coronavirus is affecting how you manage your HIV-related health care and medications?

18

Any other effects

Is there anything else we should know about how the coronavirus is affecting any other aspect of your life?

Your neighborhood?

The community of persons living with HIV?

 

RESOURCES:
* FREE MENTAL HEALTH CARE: New Yorkers can now call a hotline at 1-844-863-9314 to schedule a mental health appointment
* https://harmreduction.org/miscellaneous/covid-19-guidance-for-people-who-use-drugs-and-harm-reduction-programs/
* https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/hiv.html

Harkness, A. (2020). The Pandemic Stress Index. University of Miami

Pandemic Stress Index (PSI) – English

Please use the following citation: Harkness, A. (2020). The Pandemic Stress Index. University of Miami.

  1. What are you doing/did you do during COVID-19 (coronavirus)? (check all that apply)
    __ no changes to my life or behavior
    __ practicing social distancing (i.e., reducing your physical contact with other people in social, work, or school settings by avoiding large groups and staying 3-6 feet away from other people)
    (if yes – how long have you been doing/did you do this for? [days])
    Of these X days, how many did you end up needing to be physically near people (i.e., you were not able to practice social distancing on those days)?
    (if yes – did you choose to do this yourself or did someone else require you to?)
    (if yes – did you do this to protect someone else in your household?)
    __ isolating or quarantining yourself (i.e., while you are sick or if you have been exposed, separating yourself from other people to prevent others from getting it)
    (if yes – how long have you been doing/did you do this for? [days])
    Of these X days, how many did you end up breaking the isolation or quarantine (i.e., you were not isolated or quarantined on those days)?
    (if yes – did you choose to do this yourself or did someone else require you to?)
    (if yes – did you do this to protect someone else in your household?)
    __ caring for someone at home
    (if yes –
    __ a child or children
    __ an elderly person
    __ working from home
    (if yes – did you have to balance this with taking care of others [e.g., parents, kids, partners?])
    __ not working
    (if yes – did you lose your source of income because of COVID-19/coronavirus?)
    (if yes – why? (check all that apply)
    __ because I am/was sick or under quarantine
    __ because someone in my household was sick/under quarantine
    __ because my place of work was closed and didn’t offer a remote work option
    __ because I was laid off or lost my employment
    __ a change in use of healthcare services (e.g., calling your healthcare provider, going to urgent care, etc.)
    (if yes – was this an increase or decrease?)
    __ following media coverage related to COVID-19 (e.g., watching or reader the news, following social media coverage, etc.)
    (if yes: on average, how many hours per day did you spend on this?)
    __ changing travel plans
    (if yes – did you travel more or less?)

  2. How much is/did COVID-19 (coronavirus) impact your day-to-day life?
    1 - Not at all
    2 - A little
    3 - Much
    4 - Very much
    5 - Extremely
    9 - Decline to answer

  3. Which of the following are you experiencing (or did you experience) during COVID-19 (coronavirus)? (check all that apply)
    __ being diagnosed with COVID-19
    __ fear of getting COVID-19
    __ fear of giving COVID-19 to someone else
    __ worrying about friends, family, partners, etc.
    if yes, were you worried about people:
    __ locally
    __ in other parts of the US
    __ outside the US
    __ stigma or discrimination from other people (e.g., people treating you differently because of your identity, having symptoms, or other factors related to COVID-19)
    __ personal financial loss (e.g., lost wages, job loss, investment/retirement loss, travel-related cancelations)
    __ frustration or boredom
    __ not having enough basic supplies (e.g., food, water, medications, a place to stay)
    __ more anxiety
    __ more depression
    __ more sleep, less sleep, or other changes to your normal sleep pattern
    __ increased alcohol or other substance use
    __ a change in sexual activity
    (if yes – was this an increase or decrease?)
    __ loneliness
    __ confusion about what COVID-19 is, how to prevent it, or why social distancing/isolation/quarantines are needed
    __ feeling that I was contributing to the greater good by preventing myself or others from getting COVID-19
    __ getting emotional or social support from family, friends, partners, a counselor, or someone else
    __ getting financial support from family, friends, partners, an organization, or someone else
    __ other difficulties or challenges (We want to hear from you! Please tell us more__________)

Pandemic Stress Index (PSI) – Spanish

  1. ¿Que esta haciendo/que hizo durante COVID-19 (coronavirus)? (marque todos los que apliquen)
    ___ Ningún cambio en mi vida o comportamiento
    ___ Practiqué “distancia social” (es decir, reduje mi contacto físico con otras personas en lugares sociales, de trabajo o escolares para evitar estar en grupos grandes de personas y me mantuve a 3-6 pies de distancia de otras personas)
    (si su respuesta es Sí—cuanto tiempo lo ha estado haciendo/cuanto tiempo lo hizo? [días])
    De estos X días, cuantos días tuvo que estar físicamente cerca de otras personas (es decir, ¿cuantos días no pudo practicar distancia social)?
    (si su respuesta es Sí—¿la decisión fue suya u otra persona se lo requirió)?
    (si su respuesta es Sí—¿la decisión fue para proteger a otra persona o a miembros de su hogar?)
    ___ Me aislé o me puse en cuarentena (es decir, si estuvo enfermo o fue expuesto, se separo de otras personas para prevenir que otros se enfermaran)
    (si su respuesta es Sí—cuanto tiempo lo ha estado haciendo/cuanto tiempo lo hizo?)
    De estos X días, ¿cuantos días tuvo que romper su aislamiento o cuarentena (es decir, no estuvo aislado o en cuarentena)?
    (si su respuesta es Sí—¿la decisión fue suya u otra persona se lo obligo?)
    (si su respuesta es Sí—¿la decisión fue para proteger a otro miembro de su hogar?)
    ___ Cuide a alguien en mi casa
    (si su respuesta es Sí—
    _____niño (s)
    _____ una persona mayor de edad (anciano)
    ___ Trabaje desde casa
    (si su respuesta es Sí—¿tuvo que balancear esto con cuidar a otros [por ejemplo, tuvo que cuidar a sus padres, niños, compañero (a)]?)
    ___ No Trabaje
    (si su respuesta es Sí—perdió su fuente de ingreso debido a COVID-19 (coronavirus)?)
    (si su respuesta es Sí—¿por qué? (marque todos los que se apliquen)
    _____ porque estoy/estaba enfermo/a o estaba bajo cuarentena
    _____ porque alguien en mi hogar estaba enfermo/a o estaba bajo cuarentena
    _____ porque mi lugar de empleo estaba cerrado y no había opción de trabajar a distancia (o de manera remota)
    _____ porque hicieron ajustes de trabajo en mi compañía o me despidieron de mi trabajo
    ___ Seguí la cobertura periodística de COVID-19 (es decir, vio o leyó las noticias, siguió la cobertura por las redes sociales, etc.)
    (si su respuesta es Sí—¿que promedio de horas cada día?)
    ___ Cambie mis planes de viaje (si su respuesta es Sí)—¿viajo mas o menos?
    ___ Use mas servicios de salud (es decir, llamo mas a su proveedor de atención medica, fue al centro de urgencia medica, etc.)
    (si su respuesta es Sí—¿incremento o se redujo?)

  2. ¿Cuanto es/ fue el impacto de COVID-19 (coronavirus) en su vida cotidiana?
    1- Ninguna
    2- Un poco
    3- De cierta manera
    4- Bastante
    5- En gran manera
    9- Se niega a responder

  3. ¿Por cual de las siguientes experiencias esta pasando (o ha pasado) durante COVID-19 (coronavirus)? (Marqué todas las que apliquen)
    ___ Fui diagnosticado con COVID-19
    ___ Miedo de contagiarme con COVID-19
    ___ Miedo de contagiar a otros con COVID-19
    ___ Preocupación por amigos, familia, compañeros/as, etc.
    Si su respuesta es Sí:
    ____ En su zona local
    ____ en otras partes de los Estados Unidos
    ____ Afuera de los Estados Unidos
    ___ Estigma o discriminación de otras personas (es decir, que la gente lo trate diferente por su identidad, por tener síntomas, u otros factores relacionados con COVID-19)
    ___ Perdida financiera personal (por ejemplo, perdida de su sueldo, perdida de inversiones/retiro, cancelaciones relacionadas a viajes)
    ___ frustración o aburrimiento
    ___ No tener provisiones básicas (es decir, comida, agua, medicamentos, un lugar donde quedarse)
    ___ mas ansiedad
    ___ mas depresión
    ___ dormir mas, dormir menos, u otros cambios en su rutina normal de dormir
    ___ mas uso de bebidas alcohólicas o substancias ilícitas
    ___ un cambio en actividad sexual (si su respuesta es Sí—¿incremento o se redujo?)
    ___ soledad
    ___ confusión sobre COVID-19, como prevenirlo, o porque la distancia social, el aislamiento y la cuarentena son necesarios
    ___ la sensación que estaba contribuyendo al bien común previniendo que yo u otros nos enfermásemos con COVID-19
    ___ recibiendo apoyo emocional o social de la familia, amigos, compañeros, consejero/a, u otra persona
    ___ recibiendo apoyo financiero de la familia, amigos, compañeros, una organización u otra persona
    ___ otras dificultades o retos (¡Queremos escuchar de usted! Por favor comparta con nosotros_____)

Kalichman Covid-19 Assessment

Qualtrics Survey File (for download and import into Qualtrics)

I have a few questions I would like to ask you about your health and the health of others.

  1. Have you ever had a Flu vaccine? (No, Yes)
  2. If Yes, when was the last time you had a flu vaccine? Year of vaccine_________
  3. Have you heard of CoronaVirus, or Covid-19, a new viral infection affecting the community? (No, Yes)

IF NO, HAS NOT HEARD OF CORONAVIRUS, STOP HERE

  1. How much have heard about CoronaVirus /Covid- 19? (Not much; Some; A great deal)
  2. Have you received a test for CoronaVirus/Covid- 19? (No; Yes)
  3. Have you been diagnosed or had the CoronaVirus? (No; Yes)
  4. From 0 to 100, how concerned are you about catching the new CoronaVirus? (0=Not at all concerned; 100=Extremely Concerned)
  5. From 0 to 100, how concerned are you about someone you know catching the new CoronaVirus? (0=Not at all concerned; 100=Extremely Concerned)

The new CoronaVirus is impacting people in different ways. Have you had any of the following experiences in response to CoronaVirus?

  1. Staying indoors and away from public places. (No; Yes, a little; Yes a lot)
  2. Canceled plans that involve other people. (No; Yes, a little; Yes a lot)
  3. Been unable to get the food you need. (No; Yes, a little; Yes a lot)
  4. Been unable to get to a pharmacy because of the new CoronaVirus. (No; Yes, a little; Yes a lot)
  5. Been unable to get to medicine you need because of the new virus. (No; Yes, a little; Yes a lot)
  6. You cancelled a clinic or doctor’s appointment to avoid being around others? (No; Yes)
  7. A clinic or doctor closed or cancelled your appointment because of the new CoronaVirus? (No; Yes)
  8. A service provider of any type closed or cancelled your appointment because of the new CoronaVirus? (No; Yes)
  9. You asked others to stay away to avoid getting the new Coronavirus. (No; Yes, a little; Yes a lot)
  10. You have been asked by others to stay away to protect you from getting the virus. (No; Yes, a little; Yes a lot)
  11. Was told not to come to work or school because of the CoronaVirus. (No; Yes, a little; Yes a lot)
  12. Avoided the MARTA / Public Transportation because of the CoronaVirus. (No; Yes, a little; Yes a lot)

The Government has taken some actions to prevent the spread of the new CoronaVirus. We are interested in your opinion. There are no right or wrong answers.

Response Options: (Do not Trust at all; Slightly Trust; Somewhat Trust; Trust Completely)

  1. How much do you trust that the Government is doing all it can to prevent the spread of the CoronaVirus?
  2. How much do you trust information from the CDC about the new CoronaVirus?
  3. How much do you trust information from the Georgia Department of Public Health about the new CoronaVirus?
  4. How much do you trust information you are seeing online or in social media about the new CoronaVirus?

The following ask your opinion regarding the new CoronaVirus. How much do you agree or disagree with each statement? We are interested in your opinion. There are no right or wrong answers.

Response Options: (Strongly Agree; Somewhat Agree; Somewhat Disagree; Strongly Disagree)

  1. It should be a crime for people who know they have the virus but do not take steps to prevent from spreading it.
  2. People who test positive for the new virus should be required to wear identification tags.
  3. I am afraid of the new virus.
  4. People who test positive for new virus should be quarantined or separated by force from others.
  5. If I tested positive for the CoronaVirus people would treat me differently.
  6. If I tested positive for the CoronaVirus I would not tell anyone.
  7. People who have been to China in the past year should not be allowed into the United States.
  8. I am afraid of people who have this new virus.
  9. Areas in the city that are heavily populated by people from China should be closed off, or ‘locked down’.
  10. People who have been to China should be forced to be tested for this new virus.
  11. People from countries with more of the new virus should not be allowed in the US.

Bennett and Elliot Qualitative Interview Guide

Elliott & Bennett: Covid-19 related preliminary “risk environment” qualitative interview questions for addition to “Overdose Risk Management and Compensation in the Era of Naloxone,” revised 4/1/2020

Background Inquiry

COVID-19 Knowledge What have you heard about this coronavirus, or covid-19 as it’s being called? Do you feel like it’s a risk to you or people you know?
Media and Sources of Information Where are you receiving information about the virus? Can you talk about any news or other sources you used for information about Covid-19/coronavirus? [Probes: are people in your drug-using/non-drug-using networks talking a lot? Do you have access to TV news or different news sources on your phone, including social media?] Where do you think the virus came from?
General Perceptions of Risk How seriously are you taking this? Can you explain a little about why that is? Can you tell me a little bit about anyone in your network of friends and family who you are worried about? What kind of people do you feel are most at-risk?
Affect, Emotion, Mental Health How has this whole coronavirus outbreak affected the way you feel about things in general?
Protective Measures How are you dealing with the coronavirus threat? Have you changed anything in your day to day life? Are people around you changing their habits? Probes: Have you heard of social distancing? [If not, explain]. How do you feel about the idea that this is something we should all be doing?
Opioid-related preparation How has this affected the people you use drugs with? In what ways has the average day of substance use for you changed since the outbreak? [Probes: Stockpiling? Changed dosage? Other supplies? Emergency planning?] In what ways does coronavirus change how you think about overdose and overdose risk, if at all? [Probes: concerns about response times and willingness of peers/bystanders to intervene? Concerns about increases in solitary use?]
OAT Initiation (for those not currently in MAT) Can you talk to me about how the outbreak may have changed the way you feel about treatment? Are you more or less likely to seek buprenorphine or methadone-assisted treatment than before the outbreak? Why? Are you confident you would be able to receive treatment if you wanted it? Why or why not?

Physical Risk Environment

Treatment Availability [For those receiving OAT]. How has the virus affected your treatment? In what ways has program availability changed? How are other clients in the program behaving? How are things different for you? [Assuming mention of increased take-homes for agonist medications: Can you tell me a little bit about the experience of suddenly getting more take-homes? What are the positives and negatives of that?
Harm Reduction Resources Can you talk about your access to safe use equipment (syringes, cookers, crack pipes)? In what ways has access been impacted by the outbreak? [For those who use brick and mortar HR agencies: What’s it like not having a place to chill out? Use a clean bathroom? Talk with peers/friends?] What other services are gone or harder to access, if any?
Naloxone Availability Can you tell me about any experiences of getting naloxone refills since the outbreak? [Probe: Stockpiling? Pharmacy availability via Medicaid? Lack of access via shuttered OOPPs? Fear of losing access if more agencies are shuttered?]

Social Risk Environment

Naloxone Response-related Risk Can you tell me about how you think the coronavirus is affecting the way people think about and use naloxone? Can you tell me about your own experiences with naloxone since the outbreak? [Probe: would you feel confident using naloxone on someone overdosing? How about rescue breathing? Why or why not? What do you feel about the mouth guard provided in the standard blue-bag naloxone kit? How confident are you that it would protect you against the virus?]
Social Contexts for Use Can you tell me about any changes in the environments where you use since the virus outbreak in NYC? [Probes: do you use in public places? Have the social settings for PWID/PWUO changed? If so, where are people who used “hang out” rooms at harm reduction agencies going instead? Are there places where people still congregate and/or use together? Can you tell me about using public restrooms to inject/use?]
User Stigma How, if at all, has the virus changed your relationship with other people who use drugs? With your family or other non-using friends? Can you tell me about any ways in which you feel you’re being treated differently? Or ways in which you’re treating other people differently (potentially because of fears of transmission)?

Economic Risk Environment

Market Relations Can you talk a little about how the opioids you buy have changed, if at all, since the outbreak? Do you think the supply will be affected? Why or why not? Do you think prices will be affected? Why or why not? Do you think potency will be affected? Why or why not?
Employment and Support Can you talk to me a little about how you think the outbreak has affected your access to employment or informal wages? In what ways is it harder or easier to make money or secure benefits?
Modes of Administration For people who do not currently inject: In what ways does the outbreak and the potential for the drug supply to be affected change how you think about sniffing and injection?

Policy Risk Environment

Policy-related barriers to risk reduction What laws or policies do you think are preventing people who use drugs (or people who inject drugs) from minimizing the risk of harms right now? [Probes: Overdose? Covid-19 infection?] After mentioning slow-moving prisoner release policies from DOC and changes in take-home agonist dispensing from SAMHSA: What other changes would help you or people you know during this coronavirus epidemic?

Risk Management and Compensation

Balancing Risks What do you feel are the biggest ways in which this outbreak has affected you? And how has it affected the way you think about risks to your health? Which are the biggest right now? Why do you feel that way? What would help you the most right now in terms of limiting those risks or feeling safer? What stands in the way of that, do you think?

Stanford

  1. Have you travelled outside the U.S. since February 1st, 2020?
  1. Have you interacted with international visitors on US soil since February 1st 2020?
  1. In the past 4 weeks, have you been in close contact with a person who has tested positive for coronavirus (COVID-19)?
  1. In the past 4 weeks, have you been ill with a cold or flu-like illness?
  1. Have you been tested for COVID-19 by a medical doctor?

If you are concerned that you or a family member may be infected with COVID-19 (novel coronavirus), please contact your primary care physician or local healthcare provider.

  1. How concerned do you feel about the novel coronavirus, COVID-19? (Please select one):
  1. Have you made any changes to your lifestyle or daily activities because of COVID-19?
  1. Which of the following are you doing? (Select all that apply):
  1. Have you experienced any difficulties due to the coronavirus crisis? (Select all that apply):
  1. Tell us how the coronavirus crisis is impacting your life:
  1. Please select your top 3 concerns today (Select 3):
  1. If you were scheduled for a routine, non-urgent clinic appointment and your primary doctor was not able to see you because they were sick or in quarantine, which of the following would you prefer? (Please select one)

I would prefer to:

In an effort to reduce the spread of COVID-19, many are practicing social distancing and self-isolation. Self-isolation is the act of staying away from situations where you may be in close contact with others, such as social gatherings, work, school, faith-based gatherings, sports gatherings, restaurants and other public gatherings.

  1. To what extent are you self-isolating?
  1. What sources do you trust to provide accurate COVID-19 information? (Select all that apply):

COVID-19 Pandemic Social Distancing Event Items

These items were developed to ask people who inject drugs about how Hurricane Sandy affected them. These items can be adapted for other discrete disasters or events. Herein, we revise items referring to “Hurricane Sandy” to refer to “when COVID-19 pandemic social distancing measures were implemented” to facilitate their use in current research.

We want to ask you a few questions about how your life and activities were shaped by the COVID-19 pandemic social distancing measures.

  1. First, in the weeks immediately before the COVID-19 pandemic social distancing measures were implemented, were you homeless? CVD1
  1. Where did you stay during the beginning of when COVID-19 pandemic social distancing measures were implemented and the week after? CVD2
  1. Was this where you usually stay? CVD3
  1. If you had a place to stay: For how many days during the week after the COVID-19 pandemic social distancing measures were implemented, did the place where you stay: CVD4.1-CVD4.3
Lack electric power 0 1 2 3 4 5 6 7 9 (NA)
Lack heat 0 1 2 3 4 5 6 7 9 (NA)
Lack running water 0 1 2 3 4 5 6 7 9 (NA)
  1. During the week after when COVID-19 pandemic social distancing measures were implemented, did you help others obtain medical attention? CVD5
  1. During the week after when COVID-19 pandemic social distancing measures were implemented, did you do volunteer work with any aid group? CVD6
  1. At the time when the COVID-19 pandemic social distancing measures were implemented, were you taking prescribed methadone or buprenorphine? CVD7

IF YES, ASK:

  1. How did you get the doses of these medicines that you need? (Pick one from this list) CVD8
  1. During the week after COVID-19 pandemic social distancing measures were implemented, did drug dealers raise prices on the drugs they were selling? CVD9
  1. During the week after COVID-19 pandemic social distancing measures were implemented, did you have more difficulty getting drugs from street sources or other dealers? CVD10
  1. During the week after COVID-19 pandemic social distancing measures were implemented, on how many days were you able to get the street drugs you needed to avoid withdrawal? CVD11
  1. During the week after COVID-19 pandemic social distancing measures were implemented, did you inject drugs? CVD12

IF YES, ASK 13-19:

  1. During the week after COVID-19 pandemic social distancing measures were implemented, did the number of times you injected drugs change? CVD13
  1. During the week after COVID-19 pandemic social distancing measures were implemented, were you able to get enough sterile injection equipment from needle exchanges or other sources? CVD14

During the week after COVID-19 pandemic social distancing measures were implemented, when you injected drugs:

  1. Did you share a syringe that someone else had used previously to inject because problems related to the COVID-19 pandemic social distancing measures made it hard not to? CVD15
  1. Did you give someone a syringe to use that you already injected with because problems related to the COVID-19 pandemic social distancing measures made it hard not to? CVD16
  1. Did you share a cooker, filter or rinse water that someone else had previously used to inject because problems related to the COVID-19 pandemic social distancing measures made it hard not to? CVD17
  1. Did you backload (piggy-back) to share injection drugs because problems related to the COVID-19 pandemic social distancing measures made it hard not to? CVD18
  1. Did you inject drugs with people that you would not normally inject with because of problems related to the COVID-19 pandemic social distancing measures? CVD19

During the week after COVID-19 pandemic social distancing measures were implemented, how many times did you:

  1. Help other drug users avoid withdrawal? CVD20
  2. Help other drug users get the drugs they needed? CVD21
  3. Bring sterile syringes to other drug users who needed them? CVD22
  4. Help others by bringing them food, clothing or other necessities? CVD23

Responses:

IF ANY RESPONSES TO 20-23=ONCE OR MORE, ASK:

  1. Who were these people to whom you brought food or other necessities? CVD24.1-CVD24.5
    (Circle all that apply):
  1. During the week after COVID-19 pandemic social distancing measures were implemented, how often did you engage in sex for food, shelter, drugs, or other necessities? CVD25

IF HIV-POSITIVE, ASK:

  1. During the week after COVID-19 pandemic social distancing measures were implemented, did you miss any HIV drug doses because of related problems, such as clinics or pharmacies being closed? CVD26

REFERENCE: Pouget, E.R., Sandoval, M., Nikolopoulos, G.K., Friedman, S.R. (2015). Immediate impact of Hurricane Sandy on people who inject drugs in New York City. Substance Use & Misuse, 50:878-884. PMC4498981.

N2 COVID-19 Check-in Survey Items (phone interview)

Qualtrics Survey File (for download and import into Qualtrics)

1. In the past 2 weeks, how concerned have you been about coronavirus in your neighborhood?

  1. Not at all concerned
  2. Not very concerned
  3. Somewhat concerned
  4. Very concerned

2. In the past 2 weeks, how many friends or loved ones have you been in touch with through phone, Skype, Facebook, Zoom, WhatsApp, or face to face contact?

Number of friends or loved ones: _____________________

3. In the past 2 weeks, how many days you have been in touch with friends or loved ones through phone, skype, Facebook, zoom, WhatsApp, or face to face contact?

Number of days: _____________________

4. In the past 2 weeks, how many people have you been in close contact (within 6 feet) for 4 hours or more in a single day?

Number of people: _____________________

5. In the past 2 weeks, how many days you have been in close contact (within 6 feet) for 4 hours or more?

Number of days: _____________________

6. In the past 2 weeks, how of then have you received support (e.g., emotional, materials, or financial supports) from friends or loved ones to help you during the COVID-19 pandemic?

  1. Every day
  2. Several times a week
  3. Once a week
  4. Once in 2 weeks
  5. Never

PrEP (for HIV-negative participants): #7-#10

7. (For HIV-negative participants) Are you currently on PrEP?

  1. yes
  2. no

8. (If answer yes for question #7) In the past week, about how many days do you take PrEP?

  1. 1 day
  2. 2 days
  3. 3 days
  4. 4 days
  5. 5 days
  6. 6 days
  7. 7 days
  8. I did not take PrEP in the past week

9. How have your PrEP use changed during the COVID-19 pandemic?

  1. You have never used PrEP
  2. You have used PrEP more during COVID-19
  3. You used PrEP less during COVID-19
  4. Your PrEP use has not changed during COVID-19

10. Has your access to PrEP been impacted by the COVID-19 pandemic?

  1. Yes
  2. No

ART Use (for HIV-positive participants): #11-#14

11. (For HIV-positive participants) Are you currently taking antiretroviral medicines to treat your HIV infection?

  1. Yes
  2. No

12. (If answered yes for question #10) In the past week, about how many days do you take antiretroviral medicines?

  1. 1 day per week
  2. 2 days per week
  3. 3 days per week
  4. 4 days per week
  5. 5 days per week
  6. 6 days per week
  7. 7 days per week
  8. You did not take antiretroviral medicines in the past week

13. How has your HIV medication use changed during the COVID-19 pandemic?

  1. You have never taken HIV medication
  2. You have missed taking my HIV medications more frequently during the COVID-19 pandemic
  3. You have missed taking my HIV medications less frequently during the COVID-19 pandemic
  4. Your HIV medication use has not changed during the COVID-19 pandemic

14. Has your access to HIV medication been impacted by the COVID-19 pandemic?

  1. Yes
  2. No

[For all participants here to the end]

15. During the COVID-19 pandemic, have you had trouble finding a healthcare provider for general health, sexual health services such as HIV or STI testing, and PrEP?

  1. You have had trouble finding a healthcare provider for sexual health services such as HIV or STI testing and PrEP
  2. You have had trouble finding a healthcare provider when I feel ill or need advice about my health
  3. No

16. In the past 2 weeks, how many persons you have had sex with, including men, women, transgender women, and transgender men have you had sex with? Please include all persons in the past 2 weeks with whom you had oral, anal, or vaginal sex?

Number of persons: _______________________

17. In the past 2 weeks, how much has COVID-19 (coronavirus) impacted your sexual activity?

  1. Not at all
  2. A little
  3. Much
  4. Very much
  5. Extremely

18. [if answer 2-5 in question #17] In the past 2 weeks, how has COVID-19 impacted your sexual activity? (Check all that apply.)

  1. You have sex with main sex partner more frequently
  2. You have sex with main sex partner less frequently
  3. You have sex with casual sex partner more frequently
  4. You have sex with casual sex partner less frequently
  5. You exchange sex more frequently
  6. You exchange sex less frequently
  7. Other:________________________

19. Which of the following types of intimate partner violence are you experiencing during COVID-19? Check all that apply.

  1. You have been physically abused i.e., hit, kicked, or physically harmed by an intimate sexual partner
  2. You have been sexually abused (i.e., raped or forced to have sex against my will, fondled without consent) by an intimate sexual partner
  3. You have been emotionally abused (i.e., verbally attacked, put down) by an intimate sexual partner
  4. You have been financially abused (i.e., had my bank accounts controlled)] by an intimate sexual partner
  5. You have been intimidated by or made afraid of an intimate sexual partner

20. How likely is the following event would you experience during the COVID-19 pandemic? Check all that apply.

20.1. You would lose your source of income (e.g., lost wages, job loss)
  1. Very unlikely
  2. Somewhat unlikely
  3. Somewhat likely
  4. Very likely
  5. You have lost your source of income
  6. You did not have a source of income before the COVID-19 pandemic
20.2. You would lose your health insurance
  1. Very unlikely
  2. Somewhat unlikely
  3. Somewhat likely
  4. Very likely
  5. You have lost your health insurance
  6. You did not have health insurance before the COVID-19 pandemic
20.3. You would not have enough food.
  1. Very unlikely
  2. Somewhat unlikely
  3. Somewhat likely
  4. Very likely
  5. You do not have enough food already
20.4. You would not have enough medication to last a month
  1. Very unlikely
  2. Somewhat unlikely
  3. Somewhat likely
  4. Very likely
  5. You do not have enough medication to last a month already
20.5. You would not have a place to stay
  1. Very unlikely
  2. Somewhat unlikely
  3. Somewhat likely
  4. Very likely
  5. You do not have a place to stay already

21. In the past 2 weeks, how many days have you had a drink of an alcoholic beverage?

Number of days: ______________

22. In the past 2 weeks, how many days did you have 5 or more drinks on the same occasion?

Number of days: ______________

23. How have your drinking behavior changed during the COVID-19 pandemic?

  1. You have never drunk
  2. You have drunk more (e.g., greater frequencies or more drinks on the same occasion) during the COVID-19 pandemic
  3. You have drunk less (e.g., less frequencies or less drinks on the same occasion) during the COVID-19 pandemic
  4. Your drinking behavior remains the same during the COVID-19 pandemic

24. In the past 2 weeks, how many days did you have smoke part of or all of a cigarette?

Number of days: ______________

25. In the past 2 weeks, on the days you smoked cigarettes, how many cigarettes did you smoke per dat, on average?

  1. Less than one cigarette per day
  2. 1 cigarette per day
  3. 2 to 5 cigarettes per day
  4. 6 to 15 cigarettes per day (about ½ pack)
  5. 16 to 25 cigarettes per day (about 1 pack)
  6. 26 to 35 cigarettes per day (about 1½ packs)
  7. More than 35 cigarettes per day (about 2 packs or more)

26. In the past 2 weeks, have you used any of the following substance? (Check all substance that you use.)

▢ Erection drugs (Viagra, Cialis, etc.)
▢ Cocaine (Coke, Blow)
▢ Crystal meth (Crystal, Tina)
▢ Ecstasy (MDMA, X, E)
▢ GHB/GBL
▢ Ketamine
▢ Marijuana/Hash (Pot, Weed)
▢ Crack (Rock, Freebase)
▢ Heroin
▢ Poppers
▢ Prescription painkillers, such as oxycodone, Percocet, hydrocodone, Vicodin, Codeine, or Lortab

In the past 7 days, how often…

27. Have you felt nervous, anxious, or on edge? [Source: Adapted from the GAD-7]

28. Have you felt depressed? [Source: Adapted from the CES-D]

29. Have you felt lonely? [Source: Adapted from the CES-D]

30. Have you felt hopeful about the future? [Source: Adapted from the CES-D]

31. Have you had physical reactions, such as sweating, trouble breathing, nausea, or a pounding heart, when thinking about your experience (e.g., social distancing, loss of income/work, concerns about infection) with the coronavirus/COVID-19 pandemic? [Source: Adapted from the Impact to Event Scale - Revised]

Response options for items 27-31 are:

  1. Not at all or less than 1 day
  2. 1-2 days
  3. 3-4 days
  4. 5-7 days

Data source for the mental health items (#12-#16) above: (Core mental health questions from Johns Hopkins COVID-19 and mental health measurement working group)

32. Have you experienced any COVID-19 symptoms such as fever, coughing, upper respiratory distress, or shortness of breath?

  1. Yes
  2. No

33. How likely is it that you would become ill with coronavirus (COVID-19)?

  1. Not likely
  2. Somewhat likely
  3. Very Likely
  4. Extremely likely

34. (If you chose 2, 3 or 4 in # 32) Why do you think you are very likely or extremely likely to become ill with coronavirus?

Open ended answer: _________________________

35. How likely is it that you had sex with someone with coronavirus?

  1. Not likely
  2. Somewhat likely
  3. Very likely
  4. Extremely likely

36. Have you tested for COVID-19?

  1. Yes
  2. No

37. Have you been diagnosed with COVID-19?

  1. Yes
  2. No

38. Do you have confusion about information about COVID-19 (e.g., what is COVID-19 is, how to prevent it, or why social distancing/isolation/quarantines are needed)?

  1. Yes
  2. No

39. What do you think protects people from becoming ill with coronavirus? Please check all that apply

  1. Staying away from others or practicing social distancing) (i.e., reducing your physical contact with other people in social, work, or school settings by avoiding large groups and staying 6 feet away from other people)
  2. Taking HIV medications
  3. Herbal remedies
  4. Younger age
  5. Washing hands with soap and water more frequently
  6. Using hand sanitizer
  7. Wearing a face mask when I go out
  8. None of the above

Benoit OTP Staff Survey

OTP Staff Survey: COVID-19

Please DO NOT write your name on this survey.

Today’s Date ____/ ______/______

Demographic Information:

1. What organization do you work for?__________________________________

2. In what city is this located? _____________________________

3. What is your race? (Please circle all that apply.)

  1. White                        
  2. African-American     
  3. Latino/a          
  4. Asian/Pacific Islander       
  5. Native American      
  6. Other

4. Hispanic origin? 0. No 1. Yes

5. What is your gender?

1. Male
2. Female
3. Transgender M to F
4. Transgender F to M
5. Other

6. How many years have you worked in an addiction treatment facility?______

7. How many years have you worked in this facility?______

8. What is your job title at this facility? ______________________________

Instructions

This survey is divided into two sections. Questions in the first section ask about your program under normal operating conditions (the way in which your program functioned before the parent organization/city/state imposed COVID-19 restrictions). Questions in the second section ask about how your program managed to provide care after COVID-19 restrictions were imposed.

Under normal operating conditions, prior to COVID-19 restrictions:

9. During the month prior to COVID-19 restrictions, how many patients did you have on your individual caseload?______

10. Please estimate what percent of your patients were prescribed (circle one for each drug):

Methadone:
1) 100%       
2) 75 to 99%     
3) 50 to 74%      
4) Less than 50%
Buprenorphine (Suboxone)
1) 0%     
2) 1 to 5%    
3) 6 to 20% 
4) More than 20%
About what percent of your patients were prescribed neither methadone nor buprenorphine?______

11. What types of services did you personally provide to your patients? (Circle all that apply):

1. Dispensed medication 
2. Individual counseling 
3. Case management 
4. Group counseling 
5. HIV/AIDS counseling 
6. Intake 
7. Other_______________

12. What was the primary opioid that had been used by your patients before enrolling in treatment?

1. Heroin        
2. Prescription opioids

13. What was the medication reporting schedule of your patients? (Circle all that apply):

1.  Daily
2.  Twice a week
3.  Once a week
4.  Once every two weeks
5.  Other _____________

14. Did you speak with patients between appointments?

0. No   
1. Yes
If Yes, what percentage was hard to communicate with between appointments?

After COVID-19 restrictions were imposed:

15. When (what date) did your organization make the decision to adjust service in order to reduce patient and staff risk of exposure to COVID-19? [NYS order was issued on or around March 20] ____________

16. What steps did you take to manage risk? (circle all that apply)

1.  Patients were given take-home doses
2.  Counseling services were moved to telephone or online
3.  Patients were told about suitable substitute treatment locations
4.  Phone lists/email lists of staff members were distributed 
5.  Information was posted on website 
6.  Staff were provided with personal protective equipment
7.  We set up handwashing stations for patients
8.  Limited the number of people who could enter the site at one time
9.  Took temperatures and screened patients before they entered the building
10. No preparations were made by our organization 
11. Other:

    1.  _________________________________________________________
    2.  _________________________________________________________
    3.  _________________________________________________________

17. From 0 to 10 (0, not at all to 10, services suspended), how seriously do you feel clinic services were impeded by the precautions taken?

  0  Not at all    
  1         
  2         
  3          
  4         
  5          
  6         
  7        
  8         
  9        
  10  Totally suspended

18. What effect did COVID-19 have on the services you provide? (Circle a response)

Dispensed medication
0. No change    
1. Disrupted
Individual Counseling
0. No change    
1. Disrupted
Case Management
0. No change    
1. Disrupted
Group Counseling
0. No change    
1. Disrupted
HIV/AIDS counseling
0. No change    
1. Disrupted
Intake
0. No change    
1. Disrupted
Other_____
0. No change
1. Disrupted

19. How have services been disrupted?

20. Please estimate the percentage of your caseload that had difficulty getting their prescribed medication after restrictions were imposed. ____

  a.    For approximately how many days?_____

21. As a result of COVID19 restrictions, how did your work hours change?

0.  No change
1.  Fewer hours  
2.  Same number of hours, but different schedule
3.  Longer hours
Approximately how many days did the change in your hours last?________

22. About what percentage of your caseload were you unable to contact?

  0. None    
  1. 1-25%   
  2. 26-50%   
  3. 51-75%    
  4. 76-100%   
  7. Don’t know/Not applicable

23. About what percentage of your caseload faced transportation challenges?

  0. None    
  1. 1-25%   
  2. 26-50%   
  3. 51-75%    
  4. 76-100%   
  7. Don’t know/Not applicable

24. Approximately what percentage of your patients who could not get to your program did you refer to another facility?

  0. None    
  1. 1-25%   
  2. 26-50%   
  3. 51-75%    
  4. 76-100%   
  7. Don’t know/Not applicable

25. Please estimate the percentage of your patients who relapsed or began using more drugs as a result of COVID-19.

  0. None    
  1. 1-25%   
  2. 26-50%   
  3. 51-75%    
  4. 76-100%   
  7. Don’t know/Not applicable

26. Approximately what percentage of your patients began injecting (or increased injecting) as a result of the pandemic?

  0. None    
  1. 1-25%   
  2. 26-50%   
  3. 51-75%    
  4. 76-100%   
  7. Don’t know/Not applicable

27. How else were your patients been affected by COVID-19?

28. Did COVID-19 restrictions affect access to street drugs in the vicinity of your program?

0. No    
1. Yes     
7. Don’t know 
Please explain:

29. Was access to safe and clean drug paraphernalia affected by the restrictions?

0. No   
1. Yes     
7. Don’t know 
Please explain:

30. Was there a change in the number of persons seeking opioid treatment after the restrictions began?

0. Decrease      
1. No Change     
2. Increase
If there was a change, please explain:

31. Please estimate the percentage of your previous caseload you lost as a result of the COVID-19 restrictions:

0. None
1. 1-25%
2. 26-50%
3. 51-75%
4. 76-100%
7. Not Applicable

32. About what percentage of your total caseload is new as a result of COVID-19?______

a.  Of those new patients, what percentage is new to treatment?______ 
b. Of those new patients, what percentage came from another facility?_____

33. How have drug users in the area been affected by the lockdown?

34. Compared to before COVID-19, I feel the people on my caseload are currently being served:

1. Worse
2. About the same
3. Better
Please explain:

35. What recommendations would you make to prepare an OTP for future epidemics?

36. Would you like to add any more comments about how COVID-19 affected or continues to affect treatment at your facility?

Benoit OTP Patients Focus Group Guide

Impact of COVID-19 on people in opioid treatment programs

FOCUS GROUP GUIDE: CURRENT OTP PATIENTS

I would like you to think back to March of this year, when the spread of COVID-19 led state and local governments to issue orders for people to stay home and for non-essential businesses to close. I’m going to ask you some questions about how you were affected by these restrictions and I would like you all to share your experiences. If you are not comfortable talking about yourself in response to some questions, think of someone you know who had the same experiences. And if your own experience doesn’t fit a particular question, you can talk about the experience of someone you know.

Prior to COVID-19:

  1. Were you in treatment when you learned about COVID-19? Talk about the type of program you were in. (If not, when did you start treatment?)
  2. What medication for opioid dependence were you receiving from the program – e.g., methadone, buprenorphine?
  3. Were you receiving other medication for physical or mental health care?
  4. What did your program do to prepare you for disruption in service? For example, did they give you extra take-home medication? Refer you to another program?

After COVID-19 restrictions were imposed:

  1. Did your program close or reduce its hours because of the restrictions? When and for how long?
    1. If so, did you try to find another program?
    2. If you found another program, did your status change there? (Dosing? Schedule?)
  2. If you did not receive take-homes or find another program, how did you get the medication you needed? For how long did you have to do that?
  3. Were you stopped or harassed by police when going to your program (or anywhere else)? What happened?
  4. If you could not get your medication, what did you do? (e.g. bought heroin or other substitute, went through withdrawal, shared with friends who had supply)
  5. If you bought drugs on the street, how difficult was it? Discuss. (What was available? What was not?)
  6. If you injected drugs, were you able to get clean needles and other equipment you needed?
    1. If yes, how easy or difficult was it?
    2. If not, what did you do? Did you share needles or other equipment with anyone during this time? Discuss.
  7. What do you think could be done differently to make your experience easier the next time there is an emergency like COVID-19? What would you do differently?

Benoit People Who Use Drugs and Not Currently in Treatment Focus Group Guide

Impact of COVID-19 on people who use drugs/opioids

FOCUS GROUP GUIDE: PEOPLE NOT CURRENTLY IN TREATMENT

I would like you to think back to March of this year, when the spread of COVID-19 led state and local governments to issue orders for people to stay home and for non-essential businesses to close. I’m going to ask you some questions about how you were affected by these restrictions and I would like you all to share your experiences. If you are not comfortable talking about yourself in response to some questions, think of someone you know who had the same experiences. And if your own experience doesn’t fit a particular question, you can talk about the experience of someone you know.

Prior to COVID-19:

  1. When did you first hear about the coronavirus pandemic or COVID-19?
  2. Did you do anything to prepare for possible interruptions in services and/or supplies?
  3. Were you in treatment at the time? Using syringe exchange, other harm reduction services?
    1. If so: What did the program do to prepare you for disruption in services? (e.g., extra take-home medication or syringes, alternate sources)
    2. When did you stop going to your program? What happened?

After COVID-19 restrictions were imposed:

  1. What were you hearing about the virus? (Probes: precautions, how it spreads, risk factors, conspiracies)
  2. Did you have any trouble getting drugs from your regular sources?
    1. If so, what did you do?
    2. If not, were there changes in how drugs were sold? (e.g., social distance measures)
  3. Did COVID-19 change your drug networks or ways of using drugs? What did you do to maintain social distance? (E.g., use alone, outdoors keeping distance, virtual sessions with friends online)
  4. [For syringe access clients:] How did you obtain new syringes? If you couldn’t get to an exchange, what do you do? Did you share needles or other equipment with anyone during this time? Discuss.
  5. Were you stopped or harassed by police when going to a syringe exchange or anywhere else? What happened?
  6. Where and how did you get money for drugs during this time?
  7. Did you engage in sex to obtain drugs, money, shelter or anything else you needed?
  8. How did COVID-19 affect your mental health? (e.g., more anxious, depressed, more worried about overdose) How did you manage?
  9. What do you think could be done differently to make your experience easier the next time there is an emergency like COVID-19? What would you do differently?

ATN

COVID Questionnaire Draft (Revised 4.2.20)

What is the goal of these questions?

  • Important to know how the standard of care is being affected by the pandemic.
  • Is COVID-19 affecting the specific behaviors we are looking at for our study outcomes?
  • How much of the effect is biasing away from the null?
  • This would give information into the dips or rise that we may see into different behaviors.

How should these questions be used?

Adding questions to study follow-up will not require IRB approval. Questions related to study outcomes should be added once final questions are approved**. Additional questions are suggested and will be added at the study team’s request.

Introductory Language:

Coronavirus disease 2019 (COVID-19) is a respiratory illness that can spread from person to person. The virus that causes COVID-19 is a novel coronavirus that was first identified during an investigation into an outbreak in Wuhan, China. This next set of questions discuss how the COVID-19 pandemic has affected you.

Questions:

1. In your area, what is the management plan for COVID-19/Coronavirus? (select all that you are aware of) [this item is to set the stage for the questions that ask about changes in the COVID-response environment]

YES OR NO (take your best guess if you are not sure)

EVENT(s)
Bars are closed  Yes  No
Eating in restaurants is not allowed  Yes  No
Gathering in larger groups (more than 10 or 50 people) is not allowed  Yes  No
Gathering in any groups anywhere is not allowed  Yes  No
Retail shops are closed  Yes  No
School/in-person classes are closed  Yes  No
Work hours have been reduced  Yes  No
Work is cancelled  Yes  No
A curfew is in place  Yes  No
People are asked to remain home/in place of residence  Yes  No
Public transportation is limited or closed  Yes  No
Access to services (community centers, assistance programs, or other resources) are restricted/closed  Yes  No
Clinic service hours are reduced/restricted  Yes  No
Other? ENTER TEXT

2. Compared to the time before COVID-19/Coronavirus, please tell us if COVID-19 and the plans used to manage COVID-19 have impacted you. Please tell us only if it has changed because of COVID-19.

 

Has highly decreased because of COVID-19

Has somewhat decreased because of COVID-19

Has not changed/no different because of COVID-19

Has somewhat increased because of COVID-19

Has highly increased because of COVID-19

General

General quality of life

 

 

 

 

 

Levels of anxiety

 

 

 

 

 

Quality of sleep

 

 

 

 

 

Feeling connected to family

 

 

 

 

 

Feeling connected to friends

 

 

 

 

 

Access to resources (food, money)

 

 

 

 

 

Access to internet/stability of internet

 

 

 

 

 

Project Specific

Engaging in PROJECTNAME procedures or visits

 

 

 

 

 

Other Impacts of COVID-19 on income/housing/insurance/food

Number of paid work hours

 

 

 

 

 

Need to financially support other family/partners who have lost jobs

 

 

 

 

 

Difficulty buying food

 

 

 

 

 

Difficulty paying rent

 

 

 

 

 

Other Impacts of COVID-19 on your life?

ENTER TEXT

Risk Behaviors and Study Outcomes†

Number of sexual partners

 

 

 

 

 

Opportunities to have sex

 

 

 

 

 

Your use of dating/hook-up apps to connect virtually with other men

 

 

 

 

 

Access to condoms

 

 

 

 

 

Use of condoms

 

 

 

 

 

Your use of dating/hook-up apps to meet other men in person

 

 

 

 

 

Access to STI testing or treatment

 

 

 

 

 

Use of recreational drugs

 

 

 

 

 

Alcohol consumption

 

 

 

 

 

For youth NOT living with HIV

 

 

 

 

 

Access to HIV testing

 

 

 

 

 

Getting HIV tested

 

 

 

 

 

Getting PrEP care clinical visits

 

 

 

 

 

Access to PrEP

 

 

 

 

 

Daily adherence to PrEP

 

 

 

 

 

For youth who are transgender

 

 

 

 

 

Access to hormones

 

 

 

 

 

Adherence to hormones

 

 

 

 

 

OTHER impacts of COVID-19 on HIV prevention?

ENTER TEXT

For youth Living with HIV

 

 

 

 

 

Access to HIV meds

 

 

 

 

 

Daily adherence to HIV meds

 

 

 

 

 

Getting HIV care clinical visits

 

 

 

 

 

Getting viral loads or other labs done

 

 

 

 

 

Other impacts of COVID-19 on your HIV care?

ENTER TEXT

3. Compared to the time before COVID-19/Coronavirus, please tell us if COVID-19 and the plans used to manage COVID-19 have impacted you. Please tell us only if it has changed because of COVID-19.

Yes, because of COVID-19 No Has not changed/no different because of COVID-19
Have you lost your job, or one of your jobs?
Have you lost your insurance?
Have you become homeless or moved in with a friend due to being unable to pay housing costs?

4. How has COVID-19 and efforts to manage it influenced you, your wellbeing and sexual and mental health? [ENTER TEXT]

5. Have you had trouble getting an HIV test because of COVID-19 or the public health efforts to manage it? †

  a.    No   
  b.    Yes    
  c.    I haven’t tried to get an HIV/STI test since COVID began

6. Have you had trouble getting a STI test (like syphilis, gonorrhea or chlamydia) because of COVID-19 or the public health efforts to manage it? †

  a.    No   
  b.    Yes    
  c.    I haven’t tried to get an STI test since COVID began

For those on PrEP

7. Have you had trouble getting your PrEP prescription from your doctor because of COVID-19 or the public health efforts to manage it? †

  a.    No    
  b.    Yes    
  c.    I haven’t tried to get my prescription from my doctor

8. Have you had trouble getting your PrEP prescription filled at the pharmacy because of COVID-19 or the public health efforts to manage it? †

  a.    No   
  b.    Yes    
  c.    I haven’t tried to get my prescription filled at the pharmacy

For those getting HIV care

9. Have you had trouble getting your HIV medication prescriptions from your doctor because of COVID-19 or the public health efforts to manage it? †

  a.    No   
  b.    Yes   
  c.    I haven’t tried to get my prescriptions from my doctor

10. Have you had trouble getting your HIV medication prescriptions filled at the pharmacy because of COVID-19 or the public health efforts to manage it? †

  a.    No    
  b.    Yes    
  c.    I haven’t tried to get my prescriptions filled at the pharmacy

11. Have you had trouble making or keeping your HIV care appointments with your doctor because of COVID-19 or the public health efforts to manage it? †

  a.    No    
  b.    Yes    
  c.    I haven’t tried to have an appointment with my doctor

† If related to primary outcomes, question should be included.

University of Miami School of Nursing and Health Studies Center of Excellence for Health Disparities Research: Measures Library - COVID-19

Social Interventions Research & Evaluation Network COVID-19 Research Question Bank

PhenX Toolkit COVID-19 Protocols

National Library of Medicine Disaster Research Resource