Out-of-Pocket Expense

This survey tool collects data on how much clients or patients spend when availing STI, HIV, and AIDS-related services and/or commodities. The data collected from this tool will also be used to study how HIV-related expenditures affect the clients' or patients’ socioeconomic situation.

We appreciate your time and effort! Please remember that the feedback you will share is expenses related to when you availed any STI, HIV, AIDS services, and/or well-being care within the past six (6) months.

Important: Please note that the data collected through www.commusta.ph will be responsibly used for monitoring, research, and advocacy to improve the HIV & AIDS response in the Philippines

Note: For multiple choice questions, 🔘 means only one answer can be selected and ☑️ allows multiple answers.

OPET (Test)
Do you consent to documenting your feedback on the healthcare provider you visited? To understand TLF Share’s Privacy Policy, you may access it here.
Did you avail of any STI, HIV, AIDS services, and/or well-being care in the past 6 months?

DEMOGRAPHICS

What is your gender?
Select "Woman" if you identify as a transgender woman, cisgender woman, or woman. Choose "Man" if you identify as a transgender man, cisgender man, or man.
Do you consider yourself as?
Multiple selection allowed. You can choose more than one option.
Living Situation
Employment Status
Monthly Income Bracket
Do you have a disability?

OUT-OF-POCKET EXPENSES

Choose the items you have availed and paid for in the past 6 months
Multiple selection allowed. You can choose more than one option. Tap + to expand selection. Tap - to collapse.

ITEMS YOU PAID FOR:

CONDOMS

Is the price affordable for you?

LUBRICANTS

Is the price affordable for you?

Pre-Exposure Prophylaxis (PrEP) - first time to get pills or refill

Is the price affordable for you?

PrEp-related Medical Consultation

Is the price affordable for you?

PrEp-related Laboratories

Is the price affordable for you?

POST-EXPOSURE PROPHYLAXIS (PEP)

Is the price affordable for you?

HIV TESTING

Is the price affordable for you?

HIV CONFIRMATORY TESTING

Is the price affordable for you?

STI SCREENING/TESTING (EXAMPLE: SYPHILIS, HEPATITIS, HPV, CERVICAL CANCER)

List the STI screening or tests you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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MEDICAL CONSULTATIONS (EXAMPLE: DOCTOR OR PROFESSIONAL FEES)

Is the price affordable for you?

MEDICAL CERTIFICATE RELATED SERVICES

What medical certificate-related service did you pay for? To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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MEDICAL TESTS TAKEN TO IDENTIFY COMORBIDITIES

List the medical tests identifying comorbidities you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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MEDICATIONS FOR COMORBIDITIES PRESENT (EXAMPLE: MEDICATIONS FOR HYPERTENSION, DIABETES, OTHER COMORBIDITIES)

List the medications for comorbidities you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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OPPORTUNISTIC INFECTION MEDICATIONS (EXAMPLE: TB, CANDIDIASIS, COCCIDIOIDOMYCOSIS, PNEUMONIA, KAPOSI'S SARCOMA)

List the opportunistic infection medications you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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PROPHYLAXIS MEDICATION (EXAMPLE: AZITHROMYCIN, COTRIMOXAZOLE, ISONIAZID, OTHERS)

List the prophylaxis medication you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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ANTIRETROVIRALS OR PAYMENT FOR ANY SPECIFIC ANTIRETROVIRALS

List the specific antiretrovirals you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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ANY OTHER ARV-RELATED EXPENSES (EXAMPLE: COURIER FEE OF MEDICATIONS, STORAGE FEE)

List the ARV-related services you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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BASELINE & ROUTINE LABORATORIES (EXAMPLE: CD4, CBC, URINALYSIS, CHEST X-RAY)

Choose the baseline & routine laboratories you availed and paid for.
Is the price affordable for you?
Is the price affordable for you?
Is the price affordable for you?
Is the price affordable for you?
Is the price affordable for you?
Is the price affordable for you?

OTHER Baslenine and Routine Labs

List OTHER baseline & routine laboratories you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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OTHER RADIOLOGY AND IMAGING SERVICES FOR SPECIAL MONITORING PURPOSES

List the other radiology and imaging services you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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FAMILY PLANNING SERVICES

List the family planning services you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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PROSTATE EXAM

Is the price affordable for you?

OTHER TESTS AND SCREENING (EXAMPLE: COVID, HPV, HEPA, ETC)

List the tests or screenings you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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VACCINES (EXAMPLE: COVID, FLU, HPV, HEPA,  ETC)

Is the price affordable for you?
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SURGICAL PROCEDURES

List the surgical procedures services you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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MENTAL HEALTH RELATED SERVICES (EXAMPLE: CONSULTATION, THERAPY, TREATMENT)

List mental health services you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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SPECIAL NUTRITION NEEDS

Is the price affordable for you?

EMERGENCY SHELTER

Is the price affordable for you?

HOLISTIC WELLNESS (EXAMPLE: SPIRITUAL SERVICES, YOGA, ENERGY HEALING, AROMATHERAPY, ACUPUNCTURE, TRADITIONAL MEDICINE, ETC)

List the holistic wellness services you availed and paid for. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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STRESS MANAGEMENT SERVICES

Is the price affordable for you?

HEALTH INSURANCE

Is the price affordable for you?

OTHER CARE SERVICES

List the other care services you availed and paid for that were not covered in the previous questions. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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OTHER EXPENSES

Did you have to travel to and from the facility or service provider when you accessed testing and/or treatment services within the past 6 months?

Transportation Expenses

List the transportation services you availed and paid for (Example: Jeepney, Bus, Taxi, Grab, Tricycle, etc). To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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Did you have other personal expenses related to access to testing and/or treatment services within the past 6 months? (Example: Test Kits, Meals, etc)

Other Personal Expenses

List all other personal expenses you had to pay for during your access to testing and/or treatment. To add an item, tap the (+) button. To remove an item, tap the (-) button.
Is the price affordable for you?
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OTHER RELEVANT QUESTIONS, INCLUDING IMPACT OF OUT-OF-POCKET EXPENDITURES

Were you informed by your treatment hub that your treatment expenses can be charged against the PhilHealth Outpatient HIV/AIDS Treatment (OHAT) Package?
Did the treatment hub inform you how much they charge against the OHAT package based on the treatment services you accessed in the past 6 months?
Did you still have to pay for treatment services despite the OHAT budget?
Is this the first time you heard about OHAT?
Did you have to skip school to access the services you availed in the past 6 months?
Are you able to avail of paid leave benefits at work when you have to travel to service providers to access testing and/or treatment services?
Was your salary deducted when you could not access paid leave benefits during testing or treatment day?
This may apply to you if your employment status is “no work, no pay.”
Was your access to prevention or testing services within the past 6 months delayed because of the payments required by such services?
Did you have to skip accessing prevention or testing services within the past 6 months because of the payments required by such services?
Was your access to treatment or any treatment-related services within the past 6 months delayed because of the payments required by such services?
Did you have to skip accessing treatment or any treatment-related services within the past 6 months because of the payments required by such services?
Did you have to borrow or loan money to pay for all or either of the services you availed in the past 6 months?
In general, does paying for STI, HIV, and AIDS services impact your socioeconomic status?
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We appreciate your interest in answering this form. However, it seems that you have not availed of any STI, HIV, AIDS services, and/or well-being care in the past 6 months. 

That's okay! You can return to this form once you have availed of any of the services mentioned. Thank you very much.

Where did you find out about commusta.ph?

◘ Where did you find out about commusta.ph?
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◘ Social media post
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◘ Social media ad
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