Questionnaire for assessment of HIV/AIDS control actions in the primary care

A methodological study was conducted, based on the development of a questionnaire using an integrative review, and subsequent validation by experts, using a two-round Delphi technique. Data were analyzed by considering the level of consensus responses, associated with the Kappa index. The criteria for retaining the questions were: ≤ 75% agreement, and Kappa ≤ 0.41.

Results

The first round eliminated 16 questions, five questions were revised according to vocabulary changes requested by experts, and criteria for topic coverage and clarity. In the second round, 31 questions were considered appropriate.

Conclusion

This questionnaire, unpublished nationally or internationally, achieved acceptable content validity after a careful review of its questions.

Acquired immunodeficiency syndrome; HIV; Primary health care; Validation studies

Questions		Appropriate	Appropriate with changes	Inappropriate	K^**
Questions		n(%)*	n(%)*	n(%)*	K^**
1	Do you have access to Ministry of Health handbooks regarding the management of STIs (sexually transmitted infections)?	19(95)	0(0)	1(5)	0.459
2	Is an active search conducted to identify the groups most vulnerable to HIV/AIDS infection?	17(85)	0(0)	3(15)	0.34
3	Have you participated in training/qualification on issues related to HIV/AIDS control in the last five years?	19(95)	0(0)	1(5)	0.943
4	Is the availability of time per week for Pap smears sufficient to meet the demand?	13(65)	0(0)	7(35)	0.501
5	Is an information and awareness campaign about risk behaviors for HIV infection conducted in the coverage area of the healthcare unit?	19(95)	0(0)	1(5)	0.459
6	Is the rapid or serological test offered to every person with symptoms suggestive of HIV/AIDS?	16(80)	0(0)	4(20)	0.138
7	Is the prenatal visit performed as soon as possible, after confirmation of pregnancy, in women who have sought health services?	16(80)	1(5)	3(15)	0.852
8	Does the unit have adequate physical space for educational activities?	15(75)	2(10)	3(15)	0.608
9	Is the rapid test offered to partners of people diagnosed with HIV/AIDS?	18(90)	1(5)	1(5)	0.459
10	Is welcoming accomplished along with an initial evaluation of people diagnosed with HIV, in the area covered by the health unit?	18(90)	0(0)	2(10)	0.318
11	Do injecting drug users have access to new/sterile syringes provided by the health unit?	14(70)	0(0)	6(30)	0.306
12	Does the delivery of condoms occur outside the physical space of the health unit?	16(80)	0(0)	4(20)	0.483
13	Are people who are diagnosed with HIV/AIDS monitored by the health unit?	18(90)	0(0)	2(10)	0.773
14	In the initial assessment, are HIV users that can be followed at the unit identified, along with those who should be referred for follow-up in the Specialized Care Services?	17(85)	0(0)	3(15)	0.216
15	Is the management of HIV infection conducted in this unit?	18(90)	0(0)	2(10)	0.318
16	Are you aware of the contents of the manuals provided by the Ministry of Health regarding the measures used to control HIV/AIDS in primary care?	19(95)	0(0)	1(5)	0.459
17	Are information and awareness campaigns conducted for HIV/AIDS prevention in social facilities in the area covered by the health unit?	18(90)	1(5)	1(5)	1
18	Are the laboratory tests recommended by the Ministry of Health requested at the first visit, when a pregnancy result is positive?	20(100)	0(0)	0(0)	1
19	Does the health unit provide educative materials for educational actions?	19(95)	0(0)	1(5)	0.459
20	Is early detection for failure of antiretroviral therapy, and referral to the specialized service performed?	18(90)	0(0)	2(10)	0.318
21	Is the health unit supplied with medications for treatment of STIs (sexually transmitted infections)?	18(90)	0(0)	2(10)	0.318
22	Is the HIV serological test required for all pregnant women?	18(90)	0(0)	2(10)	0.318
23	Are people diagnosed with HIV/AIDS referred by the unit?	20(100)	0(0)	0(0)	1
24	Is an active search conducted for partners when the HIV/AIDS diagnosis is positive?	20(100)	0(0)	0(0)	1
25	Are pregnant women identified with HIV/AIDS referred for medium and high complexity services monitored by the health unit?	19(95)	0(0)	1(5)	1
26	Are condoms not only provided at specific times?	18(90)	0(0)	2(10)	0.139
27	Is HIV serological testing requested for women with complaints suggestive of gynecological infection?	19(95)	1(5)	1(5)	1
28	In the first contact with people suspected of HIV/AIDS has the diagnostic opportunity?	19(95)	1(5)	1(5)	1
29	Does the health facility provide material for rapid HIV/AIDS testing?	20(100)	0(0)	0(0)	1
30	Did you receive training to perform rapid HIV/AIDS testing?	20(100)	0(0)	0(0)	1
31	Is health education on healthy living habits conducted in social facilities in the area covered by the unit?	19(95)	0(0)	1(5)	0.459
32	With the distribution of condoms, is guidance provided on male use?	20(100)	0(0)	0(0)	1
33	Are the results of the 1^st and 2^nd HIV serology tests requested during prenatal care given to pregnant women during their pregnancy?	17(85)	0(0)	3(15)	0.608
34	Are collective educational actions addressed to the population, related to the prevention of STI (sexually transmitted infections)/AIDS, conducted?	20(100)	0(0)	0(0)	1
35	Is the HIV rapid test provided to all users of the health care facility?	18(90)	0(0)	2(10)	0.318
36	Are educational actions for information and prevention of STIs (sexually transmitted infections) offered in the health unit?	20(100)	0(0)	0(0)	1
37	Are health facility patients educated for healthy sexual habits?	18(90)	0(0)	2(10)	0.31
38	Is notification made within the SINAN (Notifiable Diseases Information System) of STIs (sexually transmitted infection) and injuries?	19(95)	0(0)	1(5)	0.459
39	Is adequate space available for the pharmacy service?	14(70)	0(0)	6(30)	0.306
40	Is an active search performed for pregnant women who began prenatal care, but did not follow through with care?	18(90)	0(0)	2(10)	0.318
41	Is the amount of condoms the unit receives per month enough to meet the demand?	20(100)	0(0)	0(0)	1
42	Is an active search conducted for people whose HIV diagnosis was positive but who did not return to receive the result?	20(100)	0(0)	0(0)	1
43	Are sex workers, homosexuals and drug users identified as vulnerable to HIV/AIDS?	13(65)	0(0)	7(35)	0.136
44	Is HIV/AIDS testing requested at the first prenatal visit?	20(100)	0(0)	0(0)	1
45	Are educational actions about HIV/AIDS provided without difficulties?	20(100)	0(0)	0(0)	1
46	Is the HIV serological test offered to patients of this unit?	19(90)	1(5)	0(0)	1
47	Do you conduct rapid HIV/AIDS pre-test and post-test counseling?	20(100)	0(0)	0(0)	1

Question	Issues evaluated	Suggestions/ Expert comments (n*)	Acceptance	Reformulated question
Is the prenatal visit performed as soon as possible, after confirmation of pregnancy, in women who have sought health services?	Scope	Focus not only on the prenatal visit, but also on screening for STIs in pregnant women, such as anti-HIV, VDRL, Hepatitis B and Hepatitis C. (1)	No	-
Does the unit have available physical space for educational activities	Vocabulary	Replace available physical space with adequate physical space. (2)	Yes	Does the unit have adequate physical space for educational activities?
Is the rapid test offered to partners of people diagnosed with HIV/AIDS?	Scope	Add to the question: is the serological test also offered? (1)	Yes	Is the rapid test or serological test offered to partners of people diagnosed with HIV/AIDS?
Are information and awareness campaigns conducted for HIV/AIDS prevention in social facilities in the area covered by the health unit?	Vocabulary	Change the term social facilities to one that facilitates understanding, for example, social spaces. (1)	No	-
Is HIV serological testing requested for women with complaints suggestive of gynecological infection?	Scope	Add to the question: if the rapid HIV test is also requested in women who have complaints suggestive of gynecological infection? (1)	Yes	Is the rapid test or HIV serological testing requested for women with complaints suggestive of gynecological infection?
In the first contact with people suspected of HIV/AIDS has the diagnostic opportunity?	Clarity	Rephrase the question in a manner that facilitates understanding. (1)	Yes	Do people suspected of HIV infection seeking the health basic unit have the opportunity to perform the diagnostic test in the health care network
Is the HIV serological test offered to patients of this unit?	Scope	Add the question: is the rapid test also offered? (1)	Yes	Is the rapid test and HIV serological test offered to patients of this unit

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author. Révia Ribeiro Castro. Alberto Maranhão Avenue, 2244, 59600-195, Mossoró, RN, Brazil. revia_ribeiro@hotmail.com

SOCIODEMOGRAPHIC AND ECONOMIC CHARACTERISTICS
Sex: ( ) Male ( ) Female
Age: _________
Family income: ( ) One minimal wage ( ) Two minimal wage ( ) Three or more
Religion: __________________________________;
Marital status: ( ) Single ( ) Married ( ) Other
Occupation:____________________________________________________;
Time working in the primary health network: ______________________;
SPECIFIC QUESTIONS
1	Do you have access to Ministry of Health handbooks regarding the management of STIs (sexually transmitted infections)?
2	Have you participated in training/qualification on issues related to HIV/AIDS control in the last five years?
3	Are information and awareness campaign about risk behavior for HIV infection conducted in the coverage area of the healthcare unit?
4	Is the prenatal visit performed as soon as possible, after confirmation of pregnancy by women who have sought the health services
5	Does the unit have adequate physical space for educational activities?
6	Is the rapid test or serological test offered to partners of people diagnosed with HIV/AIDS?
7	Does the delivery of condoms occur outside the physical space of the health unit?
8	Are people who are diagnosed with HIV/AIDS monitored by the health unit?
9	Are you aware of the contents of the manuals provided by the Ministry of Health regarding the measures used to control HIV/AIDS in primary care?
10	Are information and awareness campaigns conducted for HIV/AIDS prevention in social facilities in the area covered by the health unit?
11	Are the laboratory tests recommended by the Ministry of Health requested at the first visit, when the pregnancy result is positive?
12	Does the health unit provide educative materials for educational actions?
13	Are people diagnosed with HIV/AIDS referred by the unit?
14	Is an active search conducted for partners when the HIV/AIDS diagnosis is positive?
15	Are pregnant women identified with HIV/AIDS referred for medium and high complexity services monitored by the health unit?
16	Is the rapid test or HIV serological testing requested for women with complaints suggestive of gynecological infection?
17	Do people suspected of HIV infection at the primary health unit have an opportunity to perform the diagnostic test in the health care network?
18	Does the health facility provide material for rapid HIV/AIDS testing?
19	Did you receive training to perform rapid HIV/AIDS tests?
20	Is health education on healthy living habits conducted in social facilities in the area covered by the unit?
21	With the distribution of condoms, is guidance provided on male use?
22	Are the results of the 1st and 2nd HIV serology tests requested during prenatal care given to pregnant women during their pregnancy?
23	Are collective educational actions addressed to the population, related to the prevention of STI(sexually transmitted infections)/AIDS conducted?
24	Are educational actions for information and prevention of STIs (sexually transmitted infections) offered in the health unit?
25	Is notification made within the SINAN (Notifiable Diseases Information System) of STI (sexually transmitted infection) and injuries?
26	Is the amount of condoms the unit receives per month enough to meet the demand?
27	Is an active search conducted for people whose HIV diagnosis was positive but did not return to receive the result?
28	Is HIV/AIDS testing requested at the first prenatal visit?
29	Are educational actions about HIV/AIDS provided without difficulties?
30	Is the rapid test and HIV serological test offered to patients of this unit?
31	Do you conduct HIV/AIDS pre-test and post-test counseling?