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People living with HIV/AIDS and receiving Ryan White HIV/AIDS Program case- management services in southern Oregon, by county, as of June 2005
Source publication
Access to oral health care for people living with HIV/AIDS is a severe problem. This article describes the design and impact of an Innovations in Oral Health Care Initiative program, funded through the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance (SPNS) program, that expanded oral health-c...
Context in source publication
Citations
... The study suggests the necessity of public health campaigns to enhance patient dental awareness, promote the use of oral health programs, and alleviate dental care anxiety [58,68]. It also emphasizes the importance of good oral health for HIV-positive individuals, emphasizing the need for synchronization between medical and dental appointments, research on HIV stigma, and investment in dental practitioner training [69]. ...
Objective
The primary purpose of this study was to assess the prevalence and socio-behavioral determinants of ever-use of dental care services among adolescents aged 10–18 years, living with HIV, on Antiretroviral treatment (ART), and attending selected HIV clinics in Kampala, Uganda.
Methods
A cross-sectional study was carried out between March and September 2020. The study conveniently recruited 154 adolescents between 10 and 18 years old from 4 specific HIV clinics in Kampala. Andersen’s behavioral model guided the selection of variables, with the ever-use of dental care services as the outcome and predisposing, enabling, need-related factors and personal dental health practices as exposure variables. Data were analyzed using Fischer’s exact test for cross-tabulation and modified Poisson regression for multivariate analysis.
Results
The prevalence of ever-use of dental care services was 12.3%. The adolescents aged 14–18 had higher odds of using dental care services (Prevalence ratio (PR) of 3.35 than those aged 10–13 years. Fear of the spread of HIV was negatively associated with ever-use of dental care services (PR of 0.06). Participants who were afraid of going to the dentist had higher odds of using dental care services (PR of 2.98) than those not afraid. Failure to receive dental treatment because it was not part of the medical appointment had a positive association with the ever-use of dental care services (PR of 4.50). Those who were satisfied with their dental condition had lower odds of using dental care services. The bad oral odor was positively associated with the ever-use of dental care services (PR of 2.80). The use of soap for toothbrushing was positively associated with the ever-use of dental care services (PR of 2.51).
Conclusion
The study found a low frequency of dental care use among HIV-infected adolescents in Kampala, Uganda, with age being a predisposing factor. Enabling factors included fear of HIV spread, medical-dental appointment incoordination, and satisfaction with the dental condition and bad oral odor while under personal dental health practices. The use of soap for toothbrushing was an important association with dental care. Nevertheless, these study results cannot be generalized to the entire HIV adolescent population in Uganda.
... Poor oral hygiene is a typical clinical nding in HIV patients. Despite the obvious need for oral health services, these patients are not provided with proper dental care due to the HIV-related stigma that exists in many settings, putting them at a greater risk for developing oral and systemic diseases [49,50]. ...
Background: No systematic review/meta-analysis has been conducted on the microbiological profile associated with the occurrence of periodontitis in patients with HIV. The aim of this study was to evaluate the prevalence of identified bacteria in HIV-infected patients with periodontal disease.
Methods: Three English electronic databases (MEDLINE (via PubMed), SCOPUS, and Web of Science) were searched systematically from the beginning to 13 February 2021. The frequency of each identified bacteria in HIV-infected patients with periodontal disease was extracted. All meta-analysis methods were performed using STATA software.
Results: Twenty-two articles met inclusion criteria and enrolled into the systematic review. This review analyzed a total of 965 HIV-infected patients with periodontitis. The prevalence of periodontitis was higher in HIV-infected male patients (83% (CI95%: 76-88%)) compared to females (28% (CI95%: 17-39%)). In our study, the pooled prevalence of necrotizing ulcerative periodontitis and necrotizing ulcerative gingivitis in patients with HIV infection was 67% (CI95%: 52-82%) and 60% (CI95%: 45-74%), while a lower prevalence of linear gingivitis erythema was reported (11% (CI95%: 5-18%)). More than 140 bacterial species were identified from HIV-infected patients with periodontal disease. High prevalence of Tannerella forsythia (51% (CI95%: 5-96%)), Fusobacterium nucleatum (50% (CI95%: 21-78%)), Prevotella intermedia (50% (CI95%: 32-68%)), Peptostreptococcus micros (44% (CI95%: 25-65%)), Campylobacter rectus (35% (CI95%: 25-45%)), and Fusobacterium spp. (35% (CI95%: 3-78%)) in HIV-infected patients with periodontal disease was found.
Conclusion: Our study demonstrated that the prevalence of red and orange complex of bacteria in HIV patients with periodontal disease is relatively high.
... Other models that have been used for care coordination in dentistry so far include case managers, community health workers with specific training in oral health, or social workers, all requiring hiring or bringing in an additional provider to take on the role of care coordination, which can pose financial or logistical barriers for dental practices. Evidence on programs that currently exist are focused on increasing utilization for a particular vulnerable population (e.g., patients with HIV/AIDS or public insurance), helping patients complete treatment, or improving referrals between medicine and dentistry [15][16][17][18][19][20][21][22][23][24][25], but very rarely do studies provide thorough information on how care coordination was implemented. ...
Background
Care coordination is a key strategy used to improve health outcomes and efficiency, yet there are limited examples in dentistry. A large dental accountable care organization piloted care coordination by retraining existing administrative staff to coordinate the care of high-risk patients. Following the pilot’s success, a formal “dental care advocate” (DCA) role was integrated system-wide. The goal of this new role is to improve care, patient engagement, and health outcomes while integrating staff into the clinical care team. We aim to describe the process of DCA role implementation and assess staff and clinician perceptions about the role pre- and post-implementation.
Methods
Guided by the Consolidated Framework for Implementation Research, semi-structured interviews with clinical and operational administrative staff and observation at the company-wide training session were combined with pre- and post-implementation electronic surveys. Descriptive statistics and mean scores were tested for significance between each survey sample (t-tests), and qualitative data were thematically analyzed.
Results
With preliminary evidence from the pilot and strong executive support, a dedicated leadership team executed a stepwise rollout of the DCA role over 6 months. Success was facilitated by an organizational culture of frequent interventions deployed rapidly through a centralized system, along with supportive buy-in from managerial teams and high staff acceptance and enthusiasm for the DCA role before implementation. Following implementation, significant changes in attitudes and beliefs about the role were measured, though managers held stronger positive impressions than DCAs. DCAs reported high confidence in new skills and dental knowledge post-implementation, including motivational interviewing and the ability to confidently answer patients’ questions about their oral health. Overall, the fast-paced implementation of this new role was well received, although consistent and significant differences in mean attitudes between managers and DCAs indicate more work to fine-tune the role is needed.
Conclusions
Successful implementation of the new DCA role was facilitated by a strong organizational commitment to team-based dentistry and positive impressions of care coordination among staff and managers. Upskilling existing administrative staff with the necessary training to manage some high-risk patient needs is one method that can be used to implement care coordination efforts in dentistry.
... Poor oral hygiene is a common clinical observation in HIV-infected patients. Despite a clear necessity for oral health care, these patients are rarely provided with adequate dental treatment due to HIV-related stigma still present in many environments, which puts them automatically at higher risk for developing oral and systemic diseases (Jones et al., 2012;Patton et al., 2003). Furthermore, medical conditions accompanied by HIV infection such as lipodystrophy, nausea, vomiting, etc. often require dietary modifications (di Sibio et al., 2008;Dragović et al., 2017). ...
The importance of oral microflora composition in HIV-infected patients is well recognized. However, no studies so far have dealt with age-related changes in periodontal pathogens occurrence in HIV+ individuals. The aim of the present study was to assess and compare temporal changes of bacteria frequency in younger (≤35 years) and older (≥50 years) HIV-infected and non-infected individuals. Bacterial DNA was isolated from buccal swabs of 30 younger and 30 older subjects in both HIV+ and HIV- groups. By means of PCR the following microorganisms were detected: Aggregatibacter actinomycetemcomitans, Eikenella corrodens, Peptostreptococcus micros, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola. Oral and periodontal examinations were performed in all subjects. The prevalence of microorganisms was significantly higher in HIV+ patients compared to controls, and their distribution showed a notable shift. The decreasing incidence in HIV- subjects was: Pi>Pm>Pg>Aa>Ec>Tf>Td whilst in HIV+ it was: Pi>Pm>Ec>Pg>Tf>Aa>Td. Oral manifestations of HIV infection were more frequent in older compared to younger patients. All measured values of clinical periodontal parameters were significantly higher in older compared to younger HIV+ patients. Ageing in HIV+ subjects is accompanied with a substantial increase and rearrangements of periodontal microflora, potentially aggravating oral and systemic health.
Objective
The main purpose of this study to assess the prevalence and socio-behavioural determinants of ever-use of dental care services among the adolescents aged 10–18 years, living with HIV on Antiretroviral treatment (ART), attending selected HIV clinics in Kampala, Uganda.
Methods
A cross-sectional study was carried out between March and September 2020. The study conveniently recruited 154 adolescents between 10–18 years from 4 specific HIV clinics in Kampala. The Andersen’s behavioral model guided the selection of variables in terms of ever use of dental care services as the outcome- and predisposing, enabling, need related factors and dental health related behavior as exposure variables. Data was analyzed using Fischer’s exact test for cross-tabulation and modified Poisson regression for multivariate analysis.
Results
The prevalence of ever-use of dental care services was 12.3%. The adolescents aged 14–18 years were more likely to have used dental care services (Prevalence ratio (PR) of 3.35 (Confidence Interval (CI) 1.48–7.59) than those aged 10–13 years. Fear of spread of HIV was negatively associated with ever-use of dental care services (PR of 0.06 and CI of (0.01–0.44). Participants who were afraid of going to the dentist were more likely to have ever used dental care services (PR of 2.98 and CI of 1.41–6.30) than those not afraid. Failure to receive dental treatment because it was not part of the medical appointment had a positive association with ever-use of dental care services (PR of 4.50 (CI: 1.14–17.80). Those who were satisfied with their dental condition were less likely to have ever-used dental care services (PR of 0.21 and CI of (0.05–0.94). Bad oral odor was positively associated with ever-use of dental care services with a PR of 2.80 and CI of 1.19–6.60. Use of soap for toothbrushing was positively associated with ever-use of dental care services (PR of 2.51, CI of 1.47–4.28).
Conclusion
The study found low frequency of dental care use among HIV infected adolescents in Kampala, Uganda, with age being a predisposing factor. Enabling factors included fear of HIV spread, dental appointment failure, and satisfaction with dental condition and bad oral odor while under personal oral hygiene and dental practices, use of soap for toothbrushing was an important association of use of dental care.
The Gary and Mary West Senior Dental Center (SDC) launched in 2016 pioneering a new model of accessible and affordable dental care for vulnerable seniors. The unique SDC is co-located within a thriving senior wellness center in downtown San Diego. This article summarizes the SDC origin, new whole-person community-based integrated care model, results from the first year of operations, lessons learned and considerations for how other dental providers can better care for seniors.
This study aimed to investigate, from the perspective of People Living with HIV/Aids (PLWHA), the use of and satisfaction with public oral health services within the Unified Health System (SUS) in Fortaleza (Northeastern Brazil). Structured questionnaires on socioeconomic profile and public oral health service use and satisfaction were administered to 241 PLWHA attending eight Specialized Healthcare Services (SAE) in HIV/Aids. The mean age was 37.8 ± 9.6 years, 161 (68.3%) were male, 79 (32.8%) had completed high school, and 59 (24.5%) reported earning ≤1 minimum wage (USD 225). Only 155 (64.3%) had been to the dentist in the preceding 2 years. Of these, 68 (28.2%) attended public services, but nearly half (45.6%) did not complete treatment due to lack of supplies, malfunctioning equipment or ongoing repair of facilities. On average, the service was graded 7.6 ± 2.5, and 50 PLWHA (73.6%) reported being satisfied/very satisfied. As for humanized care, 86.7% were satisfied/very satisfied. Patients referred by SAE or residing near the facility were significantly more likely to use public services. Despite the limited use of public oral health services, mainly due to insufficient access and ineffective appointment scheduling and referral procedures, the services were mostly graded as satisfactory.
KEYWORDS:
Oral health; Access to health services; HIV
This study aimed to investigate, from the perspective of People Living with HIV/Aids (PLWHA), the use of and satisfaction with public oral health services within the Unified Health System (SUS) in Fortaleza (Northeastern Brazil). Structured questionnaires on socioeconomic profile and public oral health service use and satisfaction were administered to 241 PLWHA attending eight Specialized Healthcare Services (SAE) in HIV/Aids. The mean age was 37.8 ± 9.6 years, 161 (68.3%) were male, 79 (32.8%) had completed high school, and 59 (24.5%) reported earning ≤1 minimum wage (USD 225). Only 155 (64.3%) had been to the dentist in the preceding 2 years. Of these, 68 (28.2%) attended public services, but nearly half (45.6%) did not complete treatment due to lack of supplies, malfunctioning equipment or ongoing repair of facilities. On average, the service was graded 7.6 ± 2.5, and 50 PLWHA (73.6%) reported being satisfied/very satisfied. As for humanized care, 86.7% were satisfied/very satisfied. Patients referred by SAE or residing near the facility were significantly more likely to use public services. Despite the limited use of public oral health services, mainly due to insufficient access and ineffective appointment scheduling and referral procedures, the services were mostly graded as satisfactory.
KEYWORDS:
Oral health; Access to health services; HIV
Introduction: Dental care has remained as an unmet need for people living with HIV/AIDS (PLWHAs). Dental students are considered as future healthcare workforce and having beliefs which are discriminating may have negative attitudes towards providing care to these individuals (Azodo et al., 2010). The study aimed to assess the ethical beliefs and attitudes of dental students towards PLWHAs for providing care.
Methods: It is a descriptive correlational and cross sectional study. Nine public and private dental schools in Malaysia participated in the study. Data was collected using a validated self-administered questionnaire.
Results: A total of 481 dental students participated in this study, yielding response rate of 78%. Majority of the participants (74%) believed that patients’ HIV status should be disclosed to patients’ sexual partner without permission. Approximately 60% of the participants reported that rooms/beds of HIV patients should be clearly marked. Regarding patient disease status 28% of the students reported that it is appropriate to test a patient for HIV/AIDS without patient’s permission. Only Fifty five percent of the students expressed the willingness to treat HIV patients and 49% reported to held fear of getting infected while treating patients with HIV/AIDS. Sixty four percent of the participants reported to be more comfortable giving care to non-HIV patients than HIV-positive patients.
Conclusion: Dental students’ ethical beliefs about HIV/AIDS were not consistent with the ethical principles as stated in the code of ethics and they held negative attitudes towards PLWHAs. Ethical beliefs were found to be a determinant that may influence future attitudes of these students towards individuals with HIV/AIDS when providing care.
