Effectiveness of comprehensive ETE interventions in the dental setting

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Abstract New York City remains an important battleground in efforts to end the HIV epidemic (ETE) and many hospital based dental practices draw patients from high HIV incidence and prevalence neighborhoods. The goal of this project is to assess the acceptability, feasibility, and effectiveness of a bundle of evidence-based ETE interventions in hospital based dental clinics followed by a robust implementation evaluation if early success is realized. The proposed study will draw upon both structural information technology (IT) interventions, such as electronic medical record (EMR) alerts to prompt HIV testing, tablet-based HIV risk assessments for consideration of HIV pre-exposure prophylaxis (PrEP), and engagement dashboards to ensure or re-establish care linkage. We will also explore variations in the structure of the dental care team that might facilitate uptake and performance of comprehensive ETE activities. The proposed project is segmented into phases, commencing with the UG3 that will assess the acceptability and feasibility of introducing the IT enhanced ETE intervention bundle (testing, prevention, engagement) to a standard dental team versus care navigator augmented dental team model (Aim 1). If both models meet pre-determined acceptability and feasibility thresholds, we will conduct a comparative effectiveness study using a cluster randomized model at four sites in the UH3 to determine the optimal model (Aim 2). The optimal model will then be advanced to a full implementation evaluation at six distinct hospital dental service sites, four associated with New York Presbyterian Hospitals in Manhattan, Brooklyn and Queens and two New York City Health and Hospitals facilities located in the Bronx (Aim 3). To our knowledge no prior studies exist examining the potential of introducing a full suite of evidence-based ETE interventions into the dental care environment with careful attention to acceptability, feasibility, effectiveness and the real-world implementation challenges across multiple institutions. The successful introduction, maintenance and sustainability of comprehensive and effective HIV ETE activities in dental practices would likely prove to be a vital component of any successful ETE strategy.