Supplemental Appendix 1
Assessing Access to Assisted Reproductive Services for HIV Serodiscordant Couples
Fertility clinic call scripts
Physician Script:
The scenario is that you are an ObGyn who is new to the area and trying to get care for one of your new clinic patients. She is a 30yo G1P0 HIV negative woman with no medical issues who is married to an HIV positive man. They are trying to conceive but want to do so safely and minimize their risk of transmission to each other. Neither has a diagnosis of infertility. Your goal is to get a provider on the line to answer some questions about access for HIV patients by using this patient scenario.
START CALL
Hi this is Doctor Brown, I am a new gynecologist in the area and was hoping to speak with someone about referring a couple with HIV to your practice
->Transfer to Physician or Nurse Manager->
Did you get transferred?
1)Yes
2)No
Who did you speak with?
1)RN
2)NP/PA
3)Physician
4)Other
Thanks for your time! I wanted to ask a few questions about a couple I wanted to refer. She is HIV negative and he is HIV positive and they are trying to get pregnant.
Does your clinic offer services to couples where at least one person is HIV positive?
1)Yes
2)No
3)Not sure
If yes:
Has your clinic taken care for these couples before?
1)Yes
2)No
Does your clinic offer the following for HIV positive male / HIV negative female?
1)Sperm Washings
2)ICSI
3)Sperm Banking
If yes,
Do you still see couples if the reason for seeking services is for prevention of an infection in the female partner, for infertility only, or both?
1)To prevent infection
2)Infertility only
3)Both
If yes "To Prevent Infection" or "Both"
Do you give them PrEP [pre-exposure prophylaxis]?
1)Yes
2)No
3)Not sure
If do not give patients PrEP,
Is there a reason why?
If services NOT offered to these couples,
Can you refer me to someone who does?
1)Yes, referred to other clinic(s) that DO offer such services
2)Yes, referred to other clinic(s), but unsure if they offer such services
3)No
Any other comments or observations from your call?
Female Patient Script:
The scenario is that you [Amanda Lewis] are an HIV-negative 30-year-old woman who just moved to the area and trying to get pregnant with your HIV-positive husband. You want to have a child but want to do so safely and minimize your risk of HIV. You nor your husband has a diagnosis of infertility. Your goal is to inquire about access to assisted reproductive fertility services based on the following patient scenario.
START CALL
Hi, I have a question about services you offer. I just moved to the area with my husband and we are looking for ways to have a child. My husband is HIV positive, but I am negative and we wanted to know whether you offer services for this situation.
Did you get transferred?
1)Yes
2)No
Who did you speak with?
1)Receptionist/person that answered phone
2)NP/PA
3)Physician
Offers fertility services for this situation?
1)Yes
2)No
3)Not sure
If YES to services,
Would we be able to use my husband's sperm?
1)Yes
2)No
3)Not sure
If YES to services,
What kinds of services could you offer us?
If YES to services,
I have to check my insurance with my new employer, but do you accept insurance?
If they ask about if the services are for prevention or infertility, state “prevention” purposes & note that this question was asked and if it changed whether they provided services or not.
1)Asked
2)Not asked
3)Changed if services provided
4)Did not change if services provided
If yes to services,
Okay thank you! can I make an appointment with a doctor? [Get answer and then say, 'Actually, I am going to check my insurance and then I will call back to make the appointment].
If NO to services,
Do you know of any other clinics in the area that you could refer me to?
1)Yes, referred to other clinic(s) that DO offer such services
2)Yes, referred to other clinic(s) but unsure if they offer such services
3)No
Any other comments or observations from your call?