# Gwadz Qualitative Interview Guide (Revised April 27, 2020)

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.

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.)
__ 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

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
__ 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)
___ 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 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?)
___ 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

## 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

## 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?]

## 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?
• No, I have NOT travelled outside the U.S. since February 1st, 2020
• Yes, I have travelled outside the U.S. since February 1st, 2020
1. Have you interacted with international visitors on US soil since February 1st 2020?
• No
• Yes
1. In the past 4 weeks, have you been in close contact with a person who has tested positive for coronavirus (COVID-19)?
• No, I have NOT been in close contact with a person who has tested positive for coronavirus (COVID-19)
• Yes, I have 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?
• No
• Yes
1. Have you been tested for COVID-19 by a medical doctor?
• Yes, I was tested, and the test was positive for COVID-19
• Yes I was tested, and the test was negative for COVID-19
• No, I tried to get tested but could not get a test
• No, I have not tried to get tested

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):
• Not at all concerned
• A little concerned
• Moderately concerned
• Very concerned
• Extremely concerned
1. Have you made any changes to your lifestyle or daily activities because of COVID-19?
• Yes, I have made some changes to my lifestyle or daily activities
• No, I have not changed my lifestyle or daily activities; I am doing everything I normally do
1. Which of the following are you doing? (Select all that apply):
• More hand washing and cleaning (what if the handwashing is the same as before, e.g. at appropriate times?)
• Avoiding social gatherings
• Not attending classes
• Avoiding gym and exercise classes
• Avoiding going to the doctor or dentist for routine appointments
• Working from home
• Avoiding or cancelling domestic travel
• Avoiding or cancelling international travel
• Stocking up on food and supplies
1. Have you experienced any difficulties due to the coronavirus crisis? (Select all that apply):
• Reduced wages or work hours
• I have lost my job
• Childcare
• Getting food
• Getting hand sanitizer or cleaning supplies
• Getting routine / essential medications
• Transportation
• Accessing healthcare
1. Tell us how the coronavirus crisis is impacting your life:
• ________________________________ (open ended)
• Getting sick from the Coronavirus
• Not being able to put food on the table
• Not being able to get medical care
• Not being able to work
• Not being able to take care of family members
• I have no concerns
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:

• Wait until my doctor is available and reschedule an in-person visit with my own doctor at a future date
• Reschedule an in-person visit with a different doctor on the same day or within a few days of my original appointment
• Talk to my doctor by phone for advice during the scheduled visit time
• Send in a photo and message for advice through a secure online portal and receive a call back by phone from my doctor or care team
• Set up a video-visit with my doctor during the scheduled visit time

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?
• All of the time. I am staying at home nearly all the time
• Most of the time. I only leave my home to buy food and other essentials
• Some of the time. I have reduced the amount of times I am in public spaces, social gatherings, or at work
• None of the time. I am doing everything I normally do
• I am limiting social interaction to family members who live in my community
1. What sources do you trust to provide accurate COVID-19 information? (Select all that apply):
• Official government websites
• Newspaper
• Friends or family members
• Doctors
• CDC
• County health department
• Other
• Television news outlets such as CNN or Fox or local home town news station

# 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
• Yes
• No
• Don’t know
1. Where did you stay during the beginning of when COVID-19 pandemic social distancing measures were implemented and the week after? CVD2
• In my apartment or house
• In a relative’s or friend’s apartment or house
• In a shelter
• In the streets
• Other (specify) CVD2SP :
• Yes
• No
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
• Yes
• No
1. During the week after when COVID-19 pandemic social distancing measures were implemented, did you do volunteer work with any aid group? CVD6
• Yes
• No
1. At the time when the COVID-19 pandemic social distancing measures were implemented, were you taking prescribed methadone or buprenorphine? CVD7
• Yes
• No

1. How did you get the doses of these medicines that you need? (Pick one from this list) CVD8
• I was able to get enough take-homes from my regular program or doctor
• I was able to get some take-homes, and I also got some from other programs or doctors, so I had enough
• I got some (but not enough) from my regular program or doctor, or from other programs or doctors, so I had to use informal sources to avoid withdrawal
• I had to fend for myself and get supplies from the street or friends
• I went through withdrawal because I lacked my regular doses
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
• Yes
• No
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
• Yes
• No
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
• 0 to 7:
1. During the week after COVID-19 pandemic social distancing measures were implemented, did you inject drugs? CVD12
• Yes
• No

1. During the week after COVID-19 pandemic social distancing measures were implemented, did the number of times you injected drugs change? CVD13
• I injected less
• I injected about the same amount as usual
• I injected more
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
• Yes
• No

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
• Yes
• No
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
• Yes
• No
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
• Yes
• No
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
• Yes
• No
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
• Yes
• No

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:

• None
• Several times
• 2 or more times a day
• Don’t know

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):
• Relatives
• Friends
• Neighbors
• Other drug users
• Strangers
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
• I never do that
• I did it less
• I did it about the same amount as usual
• I did it more

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
• Yes
• No

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)

#### 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

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

1. Yes
2. No

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

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

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: _______________________

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…

#### 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)

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

#### 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

1. Yes
2. No

1. Yes
2. No

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

Today’s Date ____/ ______/______

Demographic Information:

#### 2. In what city is this located? _____________________________

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

#### 5. What is your gender?

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

#### 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:

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

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% 

#### 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:

#### 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?

  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?________

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

  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?

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

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

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

1. Worse
3. Better
Please explain:

# 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

#### 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 become homeless or moved in with a friend due to being unable to pay housing costs?

#### 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.