Service Quality Tool

We appreciate your time and effort! Please remember that the feedback you will share is about your latest access to STI, HIV, and/or AIDS services 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.

SQT (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, or AIDS services in the past six (6) months?

A. BASIC INFORMATION

Enter one or more characters to start search.

Default date is today. Tap the date to enter a different date of your last visit.
Multiple selection allowed. You can choose more than one option. Tap + to expand selection. Tap - to collapse.
WHAT WAS THE REASON WHY THE TREATMENT WAS NOT GIVEN?
WHY WAS THE TREATMENT RECEIVED LESS THAN THE PRESCRIBED AMOUNT (3 MONTHS)?
Other services
Check if there are other services you needed that are not in the list above.

Please list the other service/s that you needed

Tap 'Add' to list more services. Tap 'Remove' to remove an item. List one item per row.
Did you receive this service?
plus4 Add minus4 Remove
Your selection shows that you did not receive all of the services that you needed. Why did you not receive the services?
Multiple selection allowed. You can choose more than one option.
Who is answering this form?
How many times have you accessed services from this facility or organization in the past 6 months?
How long have you been a client of this facility or organization?

SERVICE SATISFACTION

How long did you wait before you were given the service you needed?
(hh:mm)
Did you wait too long before you were given the service you needed?
Did you receive all the information you needed and were all your questions answered?
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Was the staff professional during the interaction?
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The staff asked for my consent before any procedure or activity.
My service provider communicated with me or asked questions.
All information regarding my health was clearly explained.
All my questions were answered clearly.
I was consulted or had a say in the care that I received.
I was treated with respect by my healthcare providers.
My service provider spent enough time with me during the consultations.
Was the confidentiality of your information maintained all throughout your visit?
Which of the following was compromised?
Multiple selection allowed. You can choose more than one option.
Please limit text to 200 characters
200 characters left

How was your experience in terms of:

🌏 Location
Was the location accessible or convenient for you?
What made you feel that the location of the facility or organization was inaccessible or inconvenient?
🕒 Operating hours
How do you feel about the operating hours of the clinic?

Section

On average, what day and time works for you to receive these services?
Time
🔏 Safety
🏡 Cleanliness & ambience
₱ Affordability of Services Were the services you received affordable?
Please answer this question in general. Note that you will be asked to provide feedback on the affordability of each specific service item separately later in this form.
Would you return to this facility or organization or agency for your future sexual health or HIV service needs?
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200 characters left
Would you recommend this facility or organization or agency to anyone who needs HIV services?
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COUNSELING

How would you rate this service that you received? COUNSELING
Was this service that you received affordable? COUNSELING
PhP
Please estimate if you don't remember exact amount.

HIV INFORMATION (HIV 101)

How would you rate this service that you received? HIV INFORMATION (HIV 101)
Was this service that you received affordable? HIV INFORMATION (HIV 101)
PhP
Please estimate if you don't remember exact amount.

HIV TESTING

How would you rate this service that you received? HIV TESTING
Was this service that you received affordable? HIV TESTING
PhP
Please estimate if you don't remember exact amount.

PRE-EXPOSURE PROPHYLAXIS (PREP)

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

POST EXPOSURE PROPHYLAXIS (PEP)

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

ENROLLMENT TO HIV TREATMENT (ART)

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

REFILL OF ANTIRETROVIRAL (ARV) DRUGS

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

GRAM STAIN (FOR PENILE, VAGINAL, AND ANAL DISCHARGE)

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

PHYSICAL EXAM

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

STI INFORMATION

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

SYPHILIS CONFIRMATORY (TITER, TPPA/TPHA)

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

SYPHILIS SCREENING (RPR)

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

STI/VD TREATMENT AND MANAGEMENT

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

VISUAL INSPECTION WITH ACETIC ACID

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

AFB SPUTUM TEST

How would you rate this service that you received?
Was this service that you received affordable?
PhP
Please estimate if you don't remember exact amount.

COMPREHENSIVENESS OF HIV TESTING SERVICES

The only way a person would know if they have HIV is through an HIV test. And since HIV testing is usually the first HIV service received by people seeking and needing HIV services, the HIV testing experience needs to be informative and pleasant.

Sharing your experience would be very helpful in advocating for improving HIV testing services in the facility or organization that provided you with the service and overall in the country.
Were you given information on how HIV is transmitted?
Were you given information on how to protect yourself from HIV?
Were you given information on how HIV cannot be transmitted among people living with HIV who regularly take HIV treatment and are undetectable (U=U)?
Were you given the option to refuse or accept the test?
Were your test results explained to you?
Were you offered combination prevention services, such as PrEP or HIV treatment services?
Were you given free condoms and lubes?
Did you have enough privacy when being tested?

COMPREHENSIVENESS OF HIV TREATMENT SERVICES

Antiretroviral treatment is lifesaving for people living with HIV. That is why as much as possible, all people diagnosed with HIV must be immediately started on ARV treatment. And even more important is to stay on treatment to get an undetectable viral load and improve quality of life.

Sharing your experience would be very helpful in advocating for improving HIV treatment services in the facility or organization that provided you with the service and overall in the country.
Were you started on treatment in the past six (6) months?
From the release of your HIV test result, how long did it take before you were given ART?
Any reasons why treatment was not initiated immediately?
Were medicines you needed available at the facility?
What medicines were not available?
How many ART medicines were given to you on your last visit?
Were the medicines given to you enough for your needs?
Why were you not given the amount you needed?
Did you try to ask for more supplies?
No. of bottles
Were you provided counseling on how to be compliant with your medications for HIV (adherence counseling)?
Did you take viral load testing from this facility?
Why did you not have a viral load test?
Were you referred to other facilities or service providers?
Have you already had a viral load test this year?

COMPREHENSIVENESS OF PREP SERVICES

Pre-Exposure Prophylaxis or PrEP drugs help prevent HIV, especially for those at high risk for it. PrEP services in the country are relatively new.

Sharing your experience would be very helpful in advocating for improving PrEP services in the facility or organization that provided you with the service and overall in the country.
Is it your first time to get PrEP drugs?
How long did it take before you were given PrEP drugs?
Why were you not immediately given PrEP drugs?
What did you come in for?
Were PrEP drugs available for your refill?
Were your questions about PrEP answered?

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.
Do you have a disability?

D. VIOLENCE, HARASSMENT, STIGMA AND DISCRIMINATION

Did you experience violence, harassment, stigma and/or discrimination during this visit because of your actual or perceived HIV status?

VHSD Details

Which of the following forms of violence, harassment, stigma, and/or discrimination did you experience?
Multiple selection allowed. You can choose more than one option.
Please limit text to 300 words.
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Who committed this act against you?
Multiple selection allowed. You can choose more than one option.
Will you avoid seeking HIV & AIDS-related care, testing, and/or treatment in this facility due to your experience of violence, harassment, stigma, and/or discrimination?
Is there a complaint desk or help desk in the facility that can assist you file a report?
How did you respond to your experience of violence, harassment, stigma, and/or discrimination?
Multiple selection allowed. You can choose more than one option.
What prevented you from doing something about it?
Multiple selection allowed. You can choose more than one option.
Would you consider reporting the incident if there are organizations willing to provide you with free redress-related services?
Please provide your contact details for referral purposes.
Multiple selection allowed. You can choose more than one option.
(09
0 of 150 max characters
Where did you file a complaint or report the incident?
Multiple selection allowed. You can choose more than one option.
Did they inform you about the progress of your complaint/report?
Did they resolve the issue?
Are you satisfied with how your report was handled?
Please limit text to 200 characters
200 characters left

Where did you find out about commusta.ph?

◘ Where did you find out about commusta.ph?
Multiple selection allowed. You can choose more than one option.
◘ Social media post
Multiple selection allowed. You can choose more than one option.
◘ Social media ad
Multiple selection allowed. You can choose more than one option.