Interview Guide: HIV/HCV Cost Analysis
Appendix I: HIV and HCV Testing at Methadone Maintenance Treatment Programs Interview Guide
QUESTIONS FOR DIRECTOR OF SUD TREATMENT PROGRAM –AND/OR- HIV/HCV TESTING MANAGER 1) Can you describe the type of services that you provide at this SUD treatment program?
• OTP?
• Private (for profit/non-profit) or public?
• Medicaid managed care arrangement?
• Number of clients?
• Percent of clients covered with insurance?
2) What kind of tests are required of clients at intake?
3) Do you provide onsite HIV and/or HCV testing?
• Do you offer HIV and/or HCV ONSITE testing to 75% or more of your clients?
Onsite HIV Testing Questions:
4) Can you tell us how onsite HIV testing started at your program?
• When did it start?
• How was the decision made to implement HIV testing? What was the driving force for offering HIV testing?
• Who was the main champion for having onsite HIV testing at your organization?
• Who participated in the decision-making process?
• Who are the individuals (roles) key to the actual implementation of testing?
• Does someone (or a team) outside your organization help you with implementing HIV testing? If so, please tell me more about the agency or team and your programs arrangement with the agency.
• What was the general level of receptivity in your program/organization to implementing HIV testing? What do you think factors into the level of receptivity?
• Were there any barriers to implementation of the program?
i. Staffing or training issues?
ii. Were there any policies that made it difficult to implement?
5) What is the source of funding for HIV testing at your program?
• Would you consider this source to be temporary or permanent funding?
Interview Guide: HIV/HCV Cost Analysis
• What are the barriers to attaining/maintaining HIV testing funding?
6) What kind of local, state, or national policies, regulations, financial incentives, or guidelines influenced the decision to offer HIV testing?
7) When do clients get tested for HIV?
• Is it at intake? Does your state require testing at intake or not?
• Do you test clients annually as well? What is your policy around frequency of HIV testing after testing at intake?
8) Do you test using a rapid or blood test for HIV?
• What was the motivation for choosing to use this type of testing method?
• Who does the testing (roles)?
9) What percentage of your clients get tested for HIV?
• What are some of the reasons why clients may not test?
10)How many new HIV cases do you identify per year? What percentage of your clients are HIV positive?
11)Do you have any onsite support for patients who start treatment?
• For example, do you dispense HCV medications at the dispensary or have onsite medical providers?
12)How well do you think your current approach to HIV testing meets the needs of the individuals served by your program?
• Are you currently working towards expanding existing programs or adding other programs to support your HIV clients in the future?
13)What are your concerns, in terms of policies that may influence your decision to continue to offer HIV testing?
14)Are there any barriers to the continuation of onsite HIV testing?
• Do you have sufficient resources (staff, space, supplies, etc.) to offer HIV/HCV testing services?
• What have you done (or what do you plan to do) to get a plan in place to ensure the continuous implementation of HIV testing in your program/organization?’
Interview Guide: HIV/HCV Cost Analysis
• How confident are you that your program will be able to continue to offer HCV testing, and why?
Onsite HCV Testing Questions:
15)Can you tell us how onsite HCV testing started at your program?
• When did it start?
• How was the decision made to implement HCV testing? What was the driving force for offering HCV testing?
• Who was the main champion for having onsite HCV testing at your organization?
• Who participated in the decision-making process?
• Who are the individuals (roles) key to the actual implementation of testing?
• Does someone (or a team) outside your organization help you with implementing HCV testing? If so, please tell me more about the agency or team and your programs arrangement with the agency.
• What was the general level of receptivity in your program/organization to implementing HCV testing? What do you think factors into the level of receptivity?
• Were there any barriers to implementation of the program?
i. Staffing or training issues?
ii. Were there any policies that made it difficult to implement?
16)What is the source of funding for HCV testing at your program?
• Would you consider this source to be temporary or permanent funding?
• What are the barriers to attaining/maintaining HCV testing funding?
17)What kind of local, state, or national policies, regulations, financial incentives, or guidelines influenced the decision to offer HCV testing?
18)When do clients get tested for HCV?
• Is it at intake? Does your state require testing at intake or not?
• Do you test clients annually as well? What is your policy around frequency of HCV testing after testing at intake?
Interview Guide: HIV/HCV Cost Analysis
19)Do you test using a rapid or blood test for HCV?• What was the motivation for choosing to use this type of testing method?
• Do you do reflex testing?
• Who does the testing (roles)?
20)What percentage of your clients get tested for HCV?
• What are some of the reasons why clients may not test?
21)How many new HCV cases do you identify per year? What percentage of your clients are HCV positive?
22)Do you have any onsite support for patients who start treatment?
• For example, do you dispense HCV medications at the dispensary or have onsite medical providers?
23)How well do you think your current approach to HCV testing meets the needs of the individuals served by your program?
• Are you currently working towards expanding existing programs or adding other programs to support your HCV clients in the future?
24)What are your concerns, in terms of policies that may influence your decision to continue to offer HCV testing?
25)Are there any barriers to the continuation of onsite HCV testing?
• Do you have sufficient resources (staff, space, supplies, etc.) to offer HCV/HCV testing services?
• What have you done (or what do you plan to do) to get a plan in place to ensure the continuous implementation of HCV testing in your program/organization?’
• How confident are you that your program will be able to continue to offer HCV testing, and why?
Additional Questions around HIV/HCV Testing:
26)When you need to get something done or to solve a problem (in general, and for testing specifically), who are your "go-to" people?
27)What level of endorsement or support have you seen or heard from leaders when it comes to offering and/or sustaining HIV/HCV services?
Interview Guide: HIV/HCV Cost Analysis
28)Are there any organizational incentives for offering HIV/HCV testing? Are there incentives for staff?
29)How does the infrastructure of your organization (e.g., availability of space) affect the implementation of HIV/HCV testing?
30)How does implementation of HIV/HCV testing align with other organizational goals?
31)How well does HIV/HCV testing fit with existing workflow and other services offered by your program?
32)Have you/your unit/your organization set goals related to the implementation of HIV/HCV testing (e.g., number of clients tested, linking clients to follow-up care, etc.)?
33)Do you track HIV or HCV status of patients? If so, how do you do this?
• Do you do tracking within the EMR or outside of the EMR?
• What are the barriers to tracking HIV/HCV or using the EMR for tracking?
• How have you overcome those barriers?
34)Are there other external factors that has impacted your reasoning for offering HIV/HCV testing or the demand for testing from clients?
Interview Guide: HIV/HCV Cost Analysis
QUESTIONS FOR PERSON CONDUCTING HIV/HCV TESTING:
1) When do clients typically receive onsite HIV/HCV testing? (e.g., intake, annually, risk-based, by request, etc)
2) Walk us through your process for testing clients for HIV
• Do you prep before meeting with a client for intake? (e.g., looking at medical history before meeting with patient). If so, how much time do you spend per client?
• What do you do during intake related to HIV testing? How much time do you spend on HIV testing and/or pre-test counseling?
• If you do blood testing, does a phlebotomist do the blood draw?
• If you do rapid testing and the test comes in positive, what is your process for getting a confirmatory test?
• Where are the blood samples sent? Does your organization have an onsite lab or does it get sent out?
• When you get the test results back, what do you do if the results are negative?
• What do you do when you get back a positive HIV test?
• How are patients who have newly tested positive for HIV get linked into care? How much time does it take for you to link a person to care?
3) Walk us through your process for testing clients for HCV
• Do you prep before meeting with a client for intake? (e.g., looking at medical history before meeting with patient). If so, how much time do you spend per client?
• What do you do during intake related to HCV testing? How much time do you spend on HCV testing and/or pre-test counseling?
• If you do blood testing, does a phlebotomist do the blood draw?
• If you do rapid testing and the test comes in positive, what is your process for getting a confirmatory test? Do you have reflex testing?
• Where are the blood samples sent? Does your organization have an onsite lab or does it get sent out?
• When you get the test results back, what do you do if the results are negative?
• What do you do when you get back a positive HCV test?
• How are patients who have newly tested positive for HCV get linked into care? How much time does it take for you to link a person to care?
Interview Guide: HIV/HCV Cost Analysis
4) If you do HCV testing onsite, if a patient says they had been tested previously for HCV and were positive, how do you proceed with that patient? Do you re-test them or do you link them to treatment?
5) Do you spend any time inputting data on a client for HIV/HCV tracking purposes? How much time do you spend doing this per week?
6) When HIV/HCV testing started being offered, did it impact your workflow in any way? How much extra time did HIV/HCV testing add to your work?
7) What are the challenges and barriers you face most in offering HIV/HCV testing?
8) What are the benefits to offering HIV/HCV testing that you’ve seen?
9) Do you believe that offering HIV/HCV testing to your clients has been a positive change or a negative change? How do clients feel about it?
Interview Guide: HIV/HCV Cost Analysis
BUDGET IMPACT TOOL REVIEW WITH FINANCIAL ANALYST OR PROGRAM DIRECTOR
Note: The budget impact tool was a tool developed in a previous research study for estimating costs of providing on-site HIV testing and was adjusted to include HCV testing. We provided this tool to participants in order to receive input on whether the tool could be completed easily by programs. The following
questions are in reference to this tool.
1) What is the source of funding for the HIV/HCV testing activities at your program?
• Where does the funding come from?
• If grant-based, how many years is the funding projected to cover costs?
• Are you able to charge insurance for any of the testing services?
Counselor Salary
2) Would you be able to determine a fringe rate for employees (covers employee benefits)?
Overhead rate as a percentage of personnel costs:
3) Do you have an overhead rate (percentage of total budget) as a line item of your budget?
• Does the overhead cover costs of administration (e.g., HR) as well as costs of the building, utilities, insurance?
Unit materials costs
4) What are the costs related to the HIV and HCV tests?
5) Could you determine costs for other materials for testing, such as lances, sterile gauze pads, adhesive bandages, etc?
Recommendations:
6) Are we missing any activities or costs related to testing with this budget form? What would you recommend changing in this form?
