Form Id: FRM-APSS-FACTOR
ENGLISH  FRANÇAIS  PORTUGUÊS  ITALIANO| Refusal positive result: | |
| Feeling too sick: | |
| Does not believe in ART: | |
| There are a lot of pills: | |
| Feel better: | |
| Lack of nutrition: | |
| Lack of family support: | |
| Signs of depression/anxiety: | |
| Difficulty revealing the partnership/family: | |
| Toxicity/ Fear of side effects: | |
| Lost/Forgot/Shared pills: | |
| Stigma/Discrimination: | |
| Transportation Problems: | |
| Gender-based violence: | |
| Cultural and Traditional Aspects: | |
| Abuse of alcohol or drugs: | |
| Risk assessment: (automatic evaluation not working in preview)  | |
| Score Result: | RESULT: SCORE | 
Note: This is just a preview: not all features are guaranteed