Testing and Texting in Community Health Center Dental Clinics to Diagnose and Prevent HIV Infection

摘要 牙医可以通过提供艾滋病毒检测机会在结束艾滋病毒流行倡议中发挥重要作用 促进地理热点地区的高危人群获得艾滋病毒预防服务，从而 减少艾滋病毒感染的发生率。为了加强诊断，我们建议研究纳入 将艾滋病毒现场快速检测纳入社区卫生服务中心牙科诊所常规，提高艾滋病毒检测率。 为了扩大在牙科诊所环境中提供艾滋病毒预防服务，我们将测试患者级别的文本 信息 (TM) 干预措施旨在降低 HIV 感染高危人群的风险。在 发育UG3阶段，我们将与CHC牙科诊所患者进行定性研究，CHC牙科 提供者和牙科团队获取观点并探索促进因素、障碍和可接受性 将快速 HIV 检测和 TM 提供的预防整合到牙科诊所就诊中。该数据将用于定制 最终的干预措施将进行试点测试。这项形成性工作将促进干预措施的采用和 成功。在 UH3 试验阶段，四个 CHC 牙科诊所位于指定的 HIV 感染地理热点地区， 马萨诸塞州萨福克县将参加一项集群随机试验，比较现场快速艾滋病毒的功效 在牙科诊所进行的检测（干预）转介由牙科服务提供者进行艾滋病毒检测（对照）。当 该试验结束后，针对艾滋病毒感染高风险的牙科诊所患者进行的第二项随机对照试验将确定 短信干预在增加重复检测和减少艾滋病毒危险行为方面的功效。 UG3 的具体目标是： 1. 调查 CHC 牙科现场快速 HIV 检测的障碍和促进因素 通过对牙科患者（N = 32）和牙科服务提供者（N = 8）进行访谈来进行诊所；和焦点小组 牙科团队（N=4）； 2. 制定并实施牙科艾滋病毒快速检测综合培训 提供商； 3. 开发和规划 TM 干预，包括内容、TM 用户和交互性 通过对牙科患者进行定性访谈来提高用户吸引力和参与度的功能 (N=32)； 4. 开展艾滋病毒快速检测试点（n=1 CHC）并转介进行艾滋病毒检测（n=1 CHC）； 5. 在牙科诊所患者中进行 TM 干预试点测试（N=20）。 UH3 的具体目标是： 1. 在四家 CHC 牙科诊所中进行整群随机试验，以 确定与内部转诊相比，现场快速 HIV 检测在提高 HIV 检测率方面的功效 CHC； 2. 确定牙科诊所 HIV 检测率随时间的变化，以评估干预措施 可持续性； 3.在牙科诊所患者（N = 266）中进行一项随机临床试验，该患者的风险增加 HIV 感染以确定牙科诊所提供的 TM 是否会增加 HIV 预防服务的利用率 包括与对照 TM 状况相比，重复 HIV 检测、PrEP 摄取和 HIV 风险降低； 4. 评估干预效果发生的机制（中介）。

Abstract Dentists can play an important role in the Ending the HIV Epidemic initiative by providing access to HIV testing and facilitating access to HIV prevention services for at-risk populations in geographic hotspots, thus decreasing the incidence of HIV infection. To enhance Diagnosis, we propose to investigate incorporating routine on-site rapid HIV testing into the community health center dental clinics to increase HIV testing rates. To expand the delivery of HIV Prevention services in the dental clinic setting, we will test a patient-level text message (TM) intervention designed to decrease risk in those at high risk for HIV infection. In the developmental UG3 phase, we will conduct qualitative research with CHC dental clinic patients, CHC dental providers and dental teams to gain perspectives and explore facilitators, barriers, and acceptability of integrating rapid HIV testing and TM-delivered prevention into dental clinic visits. This data will be used to tailor the final interventions which will then be pilot tested. This formative work will facilitate intervention adoption and success. In the UH3 trial phase, four CHC dental clinics in a designated geographic hotspot for HIV infection, Suffolk County, MA, will participate in a cluster randomized trial comparing the efficacy of on-site rapid HIV testing delivered in the dental clinic (intervention) to referral for HIV testing by a dental provider (control). When that trial ends, a second RCT among dental clinic patients at high risk for HIV infection will determine the efficacy of a text messaging intervention in increasing repeat testing and reducing HIV risk behaviors. The UG3 Specific Aims are: 1. Investigate barriers and facilitators to on-site rapid HIV testing in CHC dental clinics by conducting interviews with dental patients (N=32) and dental providers (N=8); and focus groups with dental teams (N=4); 2. Develop and implement comprehensive training on rapid HIV testing for dental providers; 3. Develop and program the TM intervention, including content, and TM user and interactivity features to increase user appeal and engagement, by conducting qualitative interviews with dental patients (N=32); 4. Conduct pilot testing of rapid HIV testing (n=1 CHC) and referral for HIV testing (n=1 CHC); 5. Conduct pilot testing of the TM intervention among dental clinic patients (N=20). The UH3 Specific Aims are: 1.Conduct a cluster randomized trial among four CHC dental clinics to determine the efficacy of on-site rapid HIV testing in increasing HIV testing rates compared to referral within the CHC; 2. Determine changes in the dental clinic HIV testing rates over time to assess intervention sustainability; 3.Conduct a randomized clinical trial among dental clinic patients (N=266) at increased risk of HIV infection to determine if the dental clinic-delivered TM increases utilization of HIV prevention services including repeat HIV testing, PrEP uptake, and HIV risk reduction compared to a control TM condition; 4. Assess the mechanisms through which the intervention effects occur (mediators).