Policy Innovation Exchange (PIX) TA Request

PIX's goal is to support leaders across sectors in their efforts to advance policies related to HIV, viral hepatitis, STDs, and tuberculosis. Please fill out the form below and let us know how we can help you.

Core Information - Required

First and Last Name of Requestor

Email Address of Requestor

City and State

Enter city and state separated by a comma, like "Chicago, IL"

Location of TA Issue

If different from city and state of requestor

Organization Name of Requestor

Organization Type

If "Other", please provide the Requestor type:

Role of TA Requestor (healthcare provider, public health program staff, administrative staff, etc.)

Subject

Description of TA Need

Desired TA Outcome

How did you hear about PIX?

Additional Information

Geographic Area

TA Disease Area

HIV
STDs/STIsTBViral HepatitisOther

If "Other", please provide the disease type:

Population Focus

Adults aged 65 and over
Alaska NativeAmerican IndianAsianBlack or African AmericanHispanic, Latino or LatinxNative Hawaiian and Pacific IslanderNon-US-born personsPeople experiencing homelessnessPeople experiencing mental illnessPeople experiencing povertyPeople living in other congregate housing (not legally bound)People living in rural areasPeople who are incarceratedPeople with disabilitiesPeople with substance use disordersReligious minorityYouth and young adultsOther

If "Other", please provide the population focus:

For questions about this form, contact:

PIX-TA Team

National Network of Public Health Institutes

Email: PIXTA@nnphi.org

Website: www.nnphi.org

Disclaimer: Information collected through the PIX intake form will only be used to access and respond to your requests. No personal or identifying information will be shared by any parties not directly involved in the provision of technical assistance.

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