1.

The National Viral Hepatitis Roundtable (NVHR) has entered a 3 Year Cooperative Agreement with the Centers for Disease Control and Prevention (CDC) to increase testing for hepatitis C among individuals born between 1945 and 1965 (Baby Boomers). As part of our agreement, we plan to develop our organization’s networking, educational, and capacity-building activities and develop best practices for increasing hepatitis C testing and linkage to care.

An essential part of this agreement is understanding the current efforts around hepatitis C testing undertaken by our member organizations and other organizations around the country and opportunities to start, assist with, and spread these efforts across our networks. We are asking these questions to assess your needs for technical support and your interest in collaboration.

In this survey, we will be asking about:
•The populations your organization serves.
•The hepatitis screening and treatment services your organization provides.
•The reach of your organization.
• The needs of your organization


Please complete this brief survey to assist us in achieving this goal. Your responses will inform NVHR's program focus.

* 1. Name and contact information for your organization.

* 2. What type of general services does your organization provide? Please check all that apply.

* 3. What diseases does your organization focus on? Please check all that apply.

* 4. Which of the following services does your organization provide to clients on a regular basis? (Check all that apply)

* 5. What is the geographic reach of your organization? Please check all that apply.

* 6. Who does your organization reach? Please check the top three all that apply.

* 7. Are their specific demographic groups your organization focuses on? Please check all that apply:

* 8. Approximately how many people does your organization reach annually through DIRECT services (e.g., testing, support groups, etc.)

* 9. Approximately how many people does your organization reach annually through GENERAL services (e.g., website visitors, newsletter recipients, etc.):

* 10. Is your organization currently doing any of the following activities to increase hepatitis C testing of baby boomers? Please check all that apply.

* 11. Is your organization currently tracking rates of hepatitis C testing for baby boomer clients?

* 12. What type of technical assistance/capacity building would you be interested in receiving from NVHR regarding HCV awareness and testing for baby boomers? Please check all that apply.

* 13. From your experience, what do you feel are the biggest needs of your local community/constituents?

* 14. From your experience in your community, how adequate do you feel local resources are for the following?

  Totally Inadequate Inadequate Fair Good Excellent Don't know/not sure
HCV education
Free or reduced cost HCV screening
Resources for appropriate follow-up medical care for infected individuals
Resources for uninsured individuals to get follow-up medical care for HCV
Please rank the following items in order of importance. Items will move up or down as you rank them.

* 15. Training Needs. My organization could use assistance with:

* 16. Data Needs. My organization could use assistance with (please number in order of importance to you, with 1 being of highest importance):

* 17. Partnership Needs. My organization could use assistance with (please number in order of importance to you, with 1 being of highest importance):

* 18. Technical Assistance and Training Needs. My organization could use assistance in the following form (please number in order of importance to you, with 1 being of highest importance):

* 19. Resource Needs. My organization could use assistance with the following:

* 20. Do you have expertise in any of the following areas that may be able to help NVHR’s work? Please check all that apply.

21. Please offer additional comments regarding technical assistance or training that was not specifically mentioned, but would be helpful to you and your local communities:

Thank you for your participation. You may also email Tina Broder, Program Manager, directly with questions or comments at tbroder@nvhr.org.

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