Ashley A Leech1, Pietro Bortoletto2, Cindy Christiansen3, Mari-Lynn Drainoni4, Benjamin P Linas5, Cassandra Roeca2, Megan Curtis6, Meg Sullivan5. 1. Center for the Evaluation of Value and Risk in Health (CEVR), Tufts Medical Center, Boston, Massachusetts; Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts. Electronic address: ALeech@tuftsmedicalcenter.org. 2. Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts. 3. Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts; Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts. 4. Department of Health Law, Policy and Management, School of Public Health, Boston University, Boston, Massachusetts; Department of Medicine, Section of Infectious Diseases, School of Medicine, Boston University, Boston, Massachusetts; Evans Center for Implementation and Improvement Sciences, School of Medicine, Boston University, Boston, Massachusetts; Center for Healthcare Organization and Implementation Research, ENRM VA Hospital, Bedford, Massachusetts. 5. Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts; Department of Medicine, Center for Infectious Diseases, Boston Medical Center, Boston, Massachusetts. 6. Department of Internal Medicine, University of Washington, Seattle, Washington.
Abstract
OBJECTIVE: To understand the barriers that serodiscordant couples with human immunodeficiency virus (HIV) face in accessing services for risk reduction and infertility using assisted reproductive technology (ART). DESIGN: Two-arm cross-sectional telephone "secret shopper" study. SETTING: Infertility clinics designated by the Society for Assisted Reproductive Technology (SART), 140 from 15 American states with the highest prevalence of heterosexual HIV-infected men. PATIENT(S): Clinical and nonclinical staff at SART-registered clinics. INTERVENTION(S): Standardized telephone calls to SART-registered clinics by investigators in the roles of physician and patient callers. MAIN OUTCOME MEASURE(S): Availability and difference in services offered to callers and the rate of referral if the clinic did not provide these services. RESULT(S): Of the 140 sampled SART clinics across 15 states, callers in both patient and physician roles spoke to a staff member at greater than 90% of targeted clinics (127 clinics total). Of the physician callers 63% were told that the clinic could offer services, as compared to 40% of patient callers. Of the 55 clinics that were unable to provide services to the patient caller, 51% referred to other clinics with confidence that they could offer these services; 67% of clinics would provide services for both prevention and infertility purposes. CONCLUSION(S): Risk reduction services for HIV were more available at the sampled fertility clinics than previously reported in the literature. However, the responses depended on the person calling. The clinics demonstrated low rates of concordance with the American Society for Reproductive Medicine's guidelines, which endorse referral of patients to other facilities from sites unable to offer services.
OBJECTIVE: To understand the barriers that serodiscordant couples with human immunodeficiency virus (HIV) face in accessing services for risk reduction and infertility using assisted reproductive technology (ART). DESIGN: Two-arm cross-sectional telephone "secret shopper" study. SETTING: Infertility clinics designated by the Society for Assisted Reproductive Technology (SART), 140 from 15 American states with the highest prevalence of heterosexual HIV-infected men. PATIENT(S): Clinical and nonclinical staff at SART-registered clinics. INTERVENTION(S): Standardized telephone calls to SART-registered clinics by investigators in the roles of physician and patient callers. MAIN OUTCOME MEASURE(S): Availability and difference in services offered to callers and the rate of referral if the clinic did not provide these services. RESULT(S): Of the 140 sampled SART clinics across 15 states, callers in both patient and physician roles spoke to a staff member at greater than 90% of targeted clinics (127 clinics total). Of the physician callers 63% were told that the clinic could offer services, as compared to 40% of patient callers. Of the 55 clinics that were unable to provide services to the patient caller, 51% referred to other clinics with confidence that they could offer these services; 67% of clinics would provide services for both prevention and infertility purposes. CONCLUSION(S): Risk reduction services for HIV were more available at the sampled fertility clinics than previously reported in the literature. However, the responses depended on the person calling. The clinics demonstrated low rates of concordance with the American Society for Reproductive Medicine's guidelines, which endorse referral of patients to other facilities from sites unable to offer services.
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