As King Online in partnership with Ezintsha, we would like to offer you a free HIV self-test as part of the requirements of signing up for the PrEP project. The HIV self-test will be delivered to your preferred address by courier, this offer is limited to delivery within the City of Johannesburg and surrounding areas (refer to map) We would like your permission to contact you by phone or WhatsApp/SMS message after we have confirmed receipt of your test kit to remind you to perform the HIV test and to report the results of the test. If you are HIV negative and qualify to take part in the project, we would also like your permission to contact you by phone or WhatsApp/SMS message regarding a nurse’s visit to initiate you on PrEP.
All information obtained from you including HIV test results and personal data will be kept strictly confidential. We may also use the information collected from you to conduct analysis that will help understand and refine our screening processes. However, no one will be able to identify you from this data.
It is up to you to decide whether you agree to give us this permission (consent). If you choose not to give consent, or if at any time you wish to withdraw your consent, you are free to do so. Should you wish to discuss anything about this consent and the project, please contact any of our staff on 082 618 7851 and 064 052 3193 (24-hour number).
INFORMED CONSENT:
By selecting the yes option below, I confirm that I have read and understood this consent form and it has been explained to me in terms which I understand.
- I hereby confirm that I have been informed about the delivery of a free HIV self-test which is limited to the City of Johannesburg and surrounding areas
- I hereby confirm that I have been informed to report my HIV self-test results for the purpose of pre-screening for the project.
- I have been informed about the use of my personal data and information gathered from my HIV results, and provided the opportunity to ask any questions which have been answered to my satisfaction.
- I understand that my participation is voluntary, and I can withdraw consent at any time without being adversely affected in any way.
- I understand that I will receive an emailed copy of this document as consented below.
By selecting yes below, I confirm that I have read and understood this consent form and I hereby consent to the project team requesting my HIV results for the purposes of enrolling me into the project. By selecting no, I do not wish to participate in any screening activities for this project.