Data entry (Sign) ________ Ashodaya Samithi PrEP demonstration project 6C.Exit questionnaire visit End of Month 15 – Site: Participant unique ID number: TI number: : __ (1: FSW1 TI, Mysore, 2: FSW2 TI, Mysore, 3: Rural CC TI, Mysore, 4: FSW TI, Mandya) Date: Name and designation of person completing this form: # Topic Question Answer choices Notes characteristics 1 Current Where do you __________________ residence currently live? City/town/village/neighborhood 2 Sex work Have you received 1. Yes status or money in 2. No exchange for sex in the past 3 months? 3 Sex work Where do you __________________ location usually practice City/town/village/neighborhood sex work? 4 Frequency In the past week, Occasional clients____ Assist her of clients approximately how Repeat clients____ to quantify many occasional if and repeat clients 97. Refused necessary did you have? 5 Frequency In the past week, Number_____ Assist her of sex work approximately how to quantify many occasional 97. Refused if and repeat clients necessary did you have? 6 Income In the past Number (rupees)___ Assist her what was your to quantify average monthly 97. Refused if income? (Include necessary sex work and other work.)
Data entry (Sign) ________ Ashodaya Samithi PrEP demonstration project 6C.Exit questionnaire visit – End of Month 15 Site: Participant unique ID number: TI number: : __ (1: FSW1 TI, Mysore, 2: FSW2 TI, Mysore, 3: Rural CC TI, Mysore, 4: FSW TI, Mandya) Date: Name and designation of person completing this form: # Topic Question Answer choices Notes characteristics 1 Current residence Where do you currently live? __________________ City/town/village/neighborhood 2 Sex work status Have you received or money in exchange for sex in the past 3 months? 1. Yes 2. No 3 Sex work location Where do you usually practice sex work? __________________ City/town/village/neighborhood 4 Frequency of clients In the past week, approximately how many occasional and repeat clients did you have? Occasional clients____ Repeat clients____ 97. Refused Assist her to quantify if necessary 5 Frequency of sex work In the past week, approximately how many occasional and repeat clients did you have? Number_____ 97. Refused Assist her to quantify if necessary 6 Income In the past what was your average monthly income? (Include sex work and other work.) Number (rupees)___ 97. Refused Assist her to quantify if necessary
Ashodaya_exit-questionnaire.docx