HIV Testing in Dental Care Settings

描述（由申请人提供）：最近推出的快速艾滋病毒检测提供了一个特别有前途的筛查方法，以促进艾滋病毒感染的早期诊断。2006年9月，疾病控制和预防中心（CDC）发布了新的检测指南，将艾滋病毒筛查纳入门诊医疗保健环境。2008年12月，美国医师学会和艾滋病医学协会发布了一份指导声明，建议鼓励所有13岁以上的患者至少接受一次艾滋病病毒检测。由疾病预防控制中心、全国社区卫生中心协会和州牙科协会组织的几次全国性会议讨论了在牙科保健环境中推出快速艾滋病毒检测的问题。一些牙医也开始在他们的实践中提供艾滋病毒快速检测。然而，尽管取得了这些进展，目前几乎没有数据表明提供这种服务的可行性。为了满足这一需求，我们建议进行一项全国性的调查，在美国的2,300名牙医的代表性样本，以评估他们的知识，态度，信念和意愿的可能性，提供常规的艾滋病毒快速检测在牙科保健设置。我们还将从关键利益相关者（即，牙科保险公司和艾滋病毒/艾滋病公共卫生官员）关于可能影响牙医在其实践中提供艾滋病毒快速检测的意愿的结构性因素。本研究中收集的数据将用于告知公共卫生官员，牙科保健专业人员，政策制定者和研究人员与牙医愿意提供（或不提供）快速艾滋病毒检测相关的因素，以及探索可能破坏或促进这些服务提供的更广泛环境的各个方面。这项研究还将制定牙医谁最倾向于提供艾滋病毒快速检测在牙科保健环境的配置文件，并将提供有关潜在的结构性问题和激励措施，将需要解决，使牙科诊所提供艾滋病毒快速检测的可行场所政策相关的调查结果。这些信息可以用来告知未来的政策，提供艾滋病毒检测在牙科保健设置和促进牙科领域的培训课程的发展。拟议的项目是迈阿密大学米勒医学院、芝加哥大学和诺瓦东南大学牙科学院之间的合作。全国牙医调查的抽样框架将从美国牙科协会调查中心获得，调查将由芝加哥大学的全国民意研究中心（NORC）进行。全国牙科计划协会和全国州和地区艾滋病主任联盟将支持进行利益攸关方调查。 公共卫生相关性：广泛使用艾滋病毒快速检测有可能通过及早诊断感染者而减少死亡和疾病。这是将人们与护理联系起来并进一步减少艾滋病毒传播的第一步。牙医可以在这一倡议中发挥关键的、容易被忽视的作用。在牙科保健环境中进行艾滋病毒筛查也可以加强口腔和医疗保健系统的整合。与此同时，快速艾滋病毒检测面临着几个障碍，包括缺乏报销，未知的病人接受，未知的供应商的意愿和能力，提供这项服务。这项研究将提供关键信息的机会，和障碍，广泛实施艾滋病毒筛查在牙科保健设置。

DESCRIPTION (provided by applicant): The recent introduction of rapid HIV testing offers an especially promising screening approach for facilitating earlier diagnosis of HIV infection. In September, 2006, the Centers for Disease Control and Prevention (CDC) released new testing guidelines making it a priority to bring HIV screening into outpatient health care settings. In December, 2008, the American College of Physicians and HIV Medicine Association issued a guidance statement that recommended that all patients over the age of 13 should be encouraged to receive an HIV test at least once. Several national meetings organized by the CDC, the National Association of Community Health Centers and state dental associations have discussed the roll-out of rapid HIV testing in the dental care setting. Some dentists have also begun to offer HIV rapid testing in their practices. Yet, despite these advances, little data are currently available that inform the feasibility of offering such services. To address this need, we propose to conduct a national survey, with a representative sample of 2,300 dentists in the United States, to assess their knowledge, attitudes, beliefs and willingness regarding the possibility of offering routine HIV rapid testing in the dental care setting. We will also gather data from key stakeholders (i.e., dental insurance companies and HIV/AIDS public health officials) regarding structural factors that may influence dentists' willingness to offer HIV rapid testing in their practices. The data collected in this study will be used to inform public health officials, dental care professionals, policymakers and researchers about factors associated with dentists' willingness to offer (or not offer) rapid HIV testing as well as to explore aspects of the broader environment that can undermine or promote the delivery of these services. The study will also develop profiles of dentists who would be most inclined to offer HIV rapid testing in the dental care setting and will provide policy relevant findings about the potential structural issues and incentives that would be needed to be addressed to make the dental clinic a viable venue for offering HIV rapid testing. This information could then be used to inform future policies regarding offering HIV testing in the dental care setting and facilitate the development of training curricula for the field of dentistry. The proposed project is a collaboration among the University of Miami Miller School of Medicine, the University of Chicago and Nova Southeastern University School of Dentistry. The sampling frame for the national dentist survey will be obtained from the American Dental Association Survey Center and the survey will be conducted by the National Opinion Research Center (NORC) at the University of Chicago. The National Association of Dental Plans and the National Alliance of State and Territorial AIDS Directors will support the conduct of the stakeholder surveys. PUBLIC HEALTH RELEVANCE: Widespread use of HIV rapid testing has the potential to reduce death and illness by enabling earlier diagnosis of infected persons. This is the first step to linking people to care and reducing further HIV transmission. Dentists could play a critical, readily- overlooked role in this initiative. HIV screening in dental care settings could also enhance integration of oral and medical care health care systems. At the same time, rapid HIV testing faces several obstacles, including lack of reimbursement, unknown patient acceptance, and unknown provider willingness and ability to provide this service This study would provide critical information regarding opportunities for, and obstacles to, widespread implementation of HIV screening in dental care settings.