Module 10: HIV Testing History Form

A Module Used in The Measurement Group's Cross-Cutting Evaluation of the HRSA HIV/AIDS Bureau's Special Projects of National Significance on Innovative Models of HIV/AIDS Care

Purpose

• Code times of previous testing.
• Code previous testing history.
• Code assistance rendered at previous testing times.

• Code client belief or non-belief in previous HIV test results.

Content Domain - Develop a timeline of the HIV testing history, determine when first tested HIV-positive, services needed at time of testing, services received at time of testing, pre- and post-test counseling history.

Operational Data Items - ID Letters/ID Numbers, Site, Sub-Provider, Date, Staff Code, Client Gender, Ever Been Tested for HIV: Year This Happened, In Last Six Months, In Last 30 Days, Number of Times Tested, First Time Tested (six items), Most Recent Time (six items), Ever Tested Positive for HIV: Year This Happened, In Last Six Months, In Last 30 Days, Number of Times Tested Positive, First Time (Did Someone Help, Who Helped, Advice Given, Advice Taken), Most Recent Time (Did Someone Help, Who Helped, Advice Given, Take Advice), Ever Think You Have HIV or AIDS, Told by Doctor or Nurse: Year This Happened, In Last Six Months, In Last 30 Days, Different Times Told, Who Helped, Advice Given, Advice Taken).

Citation - Huba, G. J., Melchior, L. A., Staff of The Measurement Group, and HRSA/HAB's SPNS Cooperative Agreement Steering Committee (1996). Module 10: HIV Testing History Form. Available: www.TheMeasurementGroup.com. Culver City, California: The Measurement Group.

Usage - Permission is granted for non-commercial use so long as form is not altered, the copyright is not removed, and a proper citation is made to the instrument. Non-commercial use is use by a not-for-profit organization in which the instrument is not sold. If you have questions about appropriate and proper uses, contact The Measurement Group.