Clinic+ Follow-up Monkeypox Response Survey

NCSD is interested in assessing the impact of MPV response on sexual health clinics. All responses are confidential, and any written response will be aggregated and deidentified. The survey takes approximately five minutes to complete. Thank you for completing this survey by Tuesday, September 27th, 2022.

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1. Name

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2. Organization/Clinic Name

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3. Where is your clinic located (city and state or territory)?

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4. Which of the following best describes your clinic?

Categorical STI clinic

Federally Qualified Health Center(FQHC)/FQHC look-alike

AIDS Service Organization (ASO)

Community Based Organization (CBO)

IHS or tribal facility

Family planning clinic

Primary care provider

Other (please specify)

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5. How would you describe the demand for monkeypox testing/concern among patients at your clinic over the past four weeks?

Demand for monkeypox/concerns has significantly increased over the past four weeks

Demand for monkeypox testing/patient concerns has increased over the past four weeks

Demand for monkeypox testing/patient concerns has not changed over the past four weeks

Demand for monkeypox testing/patient concerns has decreased over the past four weeks

Demand for monkeypox testing/patient concerns has significantly decreased over the past four weeks

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6. How would you describe the ongoing demand for STI treatment?

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7. Outside of MPV what are the primary reasons people are coming in to your clinic?

routine/asymptomatic STI screening

symptomatic STI testing/treatment

Other (please specify)

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8. In the past four weeks, have medical providers referred patients to your clinic for any of the following services (check all that apply):

Referral for testing for suspected monkeypox or monkeypox symptoms

Referral for JYNNEOS vaccination

Referral for TPOXX treatment

Referral for other services that led our clinic to identifying a patient need for monkeypox testing, vaccination, or treatment

Patients have found us without a referral after being turned away from other providers

Other (please specify)

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9. Which option(s) best describes your clinic's current monkeypox testing modality? (Check all that apply)

Laboratory Response Network (LRN)/public health lab

Aegis Science

Labcorp

Mayo Clinic Laboratories

Quest Diagnostics

Sonic Healthcare

We do not currently offer monkeypox testing at my clinic.

Other (please specify)

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10. If your clinic is offering monkeypox testing through a commercial lab, how are you currently paying for this testing?

the lab is billing patient's insurance if applicable

the clinic is billing the patient's insurance if applicable

the clinic is absorbing the cost of testing

n/a - we are not currently offering monkeypox testing at my clinic

Other (please specify)

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11. How has monkeypox response impacted your clinic's capacity? (Check all that apply)

The clinic is incurring unanticipated expenses related to supplies

The clinic is incurring unanticipated expenses related to personnel

Asymptomatic screening visits have decreased because of reduced provider capacity

Symptomatic, non-monkeypox visits have decreased because of reduced provider capacity

The clinic has had to modify workflow due to monkeypox (i.e., changing from walk-in appointments to appointment-only)

The clinic has reduced capacity to support vaccine implementation efforts

Other (please specify)

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12. How has MPV response impacted your operating budget?

MPV response has significantly impacted our clinic's operating budget

MPV response has slightly impacted our clinic's operating budget

MPV response has not impacted our clinic's operating budget

Other (please specify)

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13. Please rank the following MPV response-related needs at your clinic as of today. Rank the item of most critical need for your clinic "1".

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14. How are DIS in your jurisdiction currently being utilized in monkeypox response? (please check all that apply)

assisting in MPV vaccine distribution

MPV contact tracing

community education on MPV

not assisting at this time

unsure

Other (please specify)

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15. To date, how much money would you estimate your clinic has spent on the MPV response?

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16. How confident are you in the above dollar figure?

Extremely confident

Very confident

Somewhat confident

Not so confident

Not at all confident

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17. What have been your clinic's main expenditures related to MPV response?

staffing/personnel

medical supplies

cleaning supplies

MPV testing

Other (please explain)

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18. Can you please estimate and break down the source of funding your clinic has utilized/is utilizing to support MPV response (i.e., EHE funding, PCHD, DIS funding, billing revenue, etc.,)

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19. To date, how many MPV tests has your clinic conducted?

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20. To date, what is the estimated or actual positivity rate of the MPV tests your clinic has conducted?

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21. To date, how many doses of JYNNEOS has your clinic administered? If your clinic does not administer JYNNEOS, please reply "n/a".

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22. On average, how many patient visits per week did your clinic conduct prior to the MPV outbreak?

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23. On average, how many patients visits per week does your clinic conduct currently?

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24. If your clinic received additional funding for monkeypox, how would you use it?

additional providers

additional support staff

equipment (i.e., a refrigerator to store vaccine)

PPE

monkeypox testing through a commercial lab

creation of communications materials (provider education, community education, etc.,)

MPV vaccine infrastructure (call lines, appointments, scheduling)

Other (please specify)

Clinic+ Follow-up Monkeypox Response Survey

Question Title

* 1. Name

Question Title

* 2. Organization/Clinic Name

Question Title

* 3. Where is your clinic located (city and state or territory)?

Question Title

* 4. Which of the following best describes your clinic?

Question Title

* 5. How would you describe the demand for monkeypox testing/concern among patients at your clinic over the past four weeks?

Question Title

* 6. How would you describe the ongoing demand for STI treatment?

Question Title

* 7. Outside of MPV what are the primary reasons people are coming in to your clinic?

Question Title

* 8. In the past four weeks, have medical providers referred patients to your clinic for any of the following services (check all that apply):

Question Title

* 9. Which option(s) best describes your clinic's current monkeypox testing modality? (Check all that apply)

Question Title

* 10. If your clinic is offering monkeypox testing through a commercial lab, how are you currently paying for this testing?

Question Title

* 11. How has monkeypox response impacted your clinic's capacity? (Check all that apply)

Question Title

* 12. How has MPV response impacted your operating budget?

Question Title

* 13. Please rank the following MPV response-related needs at your clinic as of today. Rank the item of most critical need for your clinic "1".

Question Title

* 14. How are DIS in your jurisdiction currently being utilized in monkeypox response? (please check all that apply)

Question Title

* 15. To date, how much money would you estimate your clinic has spent on the MPV response?

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* 16. How confident are you in the above dollar figure?

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* 17. What have been your clinic's main expenditures related to MPV response?

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* 18. Can you please estimate and break down the source of funding your clinic has utilized/is utilizing to support MPV response (i.e., EHE funding, PCHD, DIS funding, billing revenue, etc.,)

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* 19. To date, how many MPV tests has your clinic conducted?

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* 20. To date, what is the estimated or actual positivity rate of the MPV tests your clinic has conducted?

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* 21. To date, how many doses of JYNNEOS has your clinic administered? If your clinic does not administer JYNNEOS, please reply "n/a".

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* 22. On average, how many patient visits per week did your clinic conduct prior to the MPV outbreak?

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* 23. On average, how many patients visits per week does your clinic conduct currently?

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* 24. If your clinic received additional funding for monkeypox, how would you use it?

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* 25. Without additional funding and support, how long would you estimate your clinic can continue operating the way it is?

1. Name

2. Organization/Clinic Name

3. Where is your clinic located (city and state or territory)?

4. Which of the following best describes your clinic?

5. How would you describe the demand for monkeypox testing/concern among patients at your clinic over the past four weeks?

6. How would you describe the ongoing demand for STI treatment?

7. Outside of MPV what are the primary reasons people are coming in to your clinic?

8. In the past four weeks, have medical providers referred patients to your clinic for any of the following services (check all that apply):

9. Which option(s) best describes your clinic's current monkeypox testing modality? (Check all that apply)

10. If your clinic is offering monkeypox testing through a commercial lab, how are you currently paying for this testing?

11. How has monkeypox response impacted your clinic's capacity? (Check all that apply)

12. How has MPV response impacted your operating budget?

13. Please rank the following MPV response-related needs at your clinic as of today. Rank the item of most critical need for your clinic "1".

14. How are DIS in your jurisdiction currently being utilized in monkeypox response? (please check all that apply)

15. To date, how much money would you estimate your clinic has spent on the MPV response?

16. How confident are you in the above dollar figure?

17. What have been your clinic's main expenditures related to MPV response?

18. Can you please estimate and break down the source of funding your clinic has utilized/is utilizing to support MPV response (i.e., EHE funding, PCHD, DIS funding, billing revenue, etc.,)

19. To date, how many MPV tests has your clinic conducted?

20. To date, what is the estimated or actual positivity rate of the MPV tests your clinic has conducted?

21. To date, how many doses of JYNNEOS has your clinic administered? If your clinic does not administer JYNNEOS, please reply "n/a".

22. On average, how many patient visits per week did your clinic conduct prior to the MPV outbreak?

23. On average, how many patients visits per week does your clinic conduct currently?

24. If your clinic received additional funding for monkeypox, how would you use it?

25. Without additional funding and support, how long would you estimate your clinic can continue operating the way it is?