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，在终止艾滋病毒流行倡议中发挥重要作用 并促进热点地区高危人群获得艾滋病毒预防服务， 降低艾滋病毒感染率。为了加强诊断，我们建议调查纳入 将艾滋病病毒常规现场快速检测纳入社区卫生中心牙科门诊，提高艾滋病病毒检测率。 为了在牙科诊所扩大艾滋病预防服务的提供，我们将测试一个病人级别的文本 信息（TM）干预，旨在降低艾滋病毒感染高危人群的风险。在 发展UG 3阶段，我们将进行定性研究与CHC牙科诊所的病人，CHC牙科 提供者和牙科团队，以获得观点，并探讨促进者，障碍和可接受性 将快速艾滋病毒检测和TM提供的预防纳入牙科诊所就诊。这些数据将用于定制 最后的干预措施，然后将进行试点测试。这项形成性工作将促进干预措施的采用， 成功在UH 3试验阶段，在指定的艾滋病毒感染热点地区的四个CHC牙科诊所， 马萨诸塞州萨福克县将参加一项随机分组试验，比较现场快速艾滋病毒治疗的疗效。 在牙科诊所进行的艾滋病毒检测（干预）到牙科服务提供者转诊进行的艾滋病毒检测（对照）。当 试验结束后，在牙科诊所HIV感染高危患者中进行的第二项RCT将确定 短信干预在增加重复检测和减少艾滋病毒风险行为方面的有效性。 UG 3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 通过与牙科患者（N=32）和牙科提供者（N=8）进行访谈， 牙科团队（N=4）; 2.制定和实施关于牙科医生艾滋病毒快速检测的全面培训 供应商; 3.开发和规划TM干预措施，包括内容、TM用户和交互性 通过对牙科患者进行定性访谈，增加用户吸引力和参与度 （N=32）; 4.开展艾滋病毒快速检测试点（n=1个社区卫生中心）和艾滋病毒检测转诊（n=1个社区卫生中心）; 5. 在牙科诊所患者（N=20）中进行TM干预的试点测试。 UH 3的具体目标是：1.在四个CHC牙科诊所中进行一项集群随机试验， 确定现场快速艾滋病毒检测在提高艾滋病毒检测率方面的有效性， CHC; 2.确定牙科诊所艾滋病毒检测率随时间的变化，以评估干预措施 3.在牙科门诊患者（N=266）中进行随机临床试验， 艾滋病毒感染，以确定牙科诊所提供的TM是否增加了艾滋病毒预防服务的利用率 包括与对照TM条件相比，重复HIV检测、PrEP摄取和HIV风险降低; 4. 评估干预效应发生的机制（介质）。

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).