Addressing Dental and Psychiatric Comorbidities: Screening and Referrals of HIV/AIDS Patients

艾滋病毒/艾滋病患者(PLWHA)在牙科和牙科方面的研究和服务不足 心理健康服务，与普通人群相比。PLWHA中的精神和牙科合并症 导致诊断复杂、治疗差距、卫生保健成本增加和预后较差。早些时候 提供诊断和治疗服务势在必行。美国没有关于口腔共患疾病和 PLWHA中的精神疾病。评估治疗需求、自我管理和病例管理可以 告知改善的转诊和治疗结果。研究已经确定了PLWHA中的牙科护理障碍， 包括支付能力、牙科焦虑、交通等。患者、艾滋病毒项目主任、病例经理和 管理人员是了解PLWHA使用牙科和精神卫生服务的关键利益相关者。他们的 转诊成功与否没有通过传统的艾滋病毒监测进行评估。成功转诊的因素 PLWHA对精神健康和牙科服务的研究不足。检查被认为是关联的因素 PLWHA、项目主任和其他工作人员，包括基于激励自决理论的作用 (SDT)机制是必要的。这项拟议的研究将审查与转诊到牙科的PLWHA相关的因素 和心理健康服务，并描述105名PLWHA的并存情况，他们的自我 管理，以及他们对病例管理的看法。所有患者(有或无合并症)将 评估过了。主要研究结果是保留牙科和/或精神健康转诊预约。 目的1)检查1)口腔筛查者的转诊关联因素(社会、生物或行为) 只有疾病，2)只有精神疾病，3)口腔疾病和精神疾病，或4)都不是(比较 组)。其他评估包括8次关键线人访谈(KIIS)，2次焦点小组(FGs)，8-12次 每个参与者和验证的调查。 目标2：2)描述PLWHA样本中的共病患病率，即自我管理的使用 基于筛查和临床数据(唾液性牙周炎)的策略及其转诊需求 生物标记物IL-6在基线上)；2b)评估可行性并获得试点数据，以便为未来的动机提供信息 针对PLWHA口腔和心理健康行为的干预。 目标3：通过患者筛查、唾液临床检查来检查6个月后的健康状况 生物标志物和一项调查。 假设：PLWHA牙科/精神并存筛查阳性将减少转诊时间 而不是那些筛查呈阳性的患者。这可能与转介的SDT动机指数和 联动因素。这项创新的混合方法研究将为患者、牙科患者提供所需的证据基础 和精神健康专业人员和其他利益相关者，以及未来的研究(例如，随机临床 试验)和潜在的干预措施，如激励性面谈战略，以最大限度地提高成功的转介。

Persons living with HIV/AIDS (PLWHA) are understudied and underserved with respect to both dental and mental health services, compared to the general population. Psychiatric and dental comorbidities in PLWHA result in diagnostic complexities, treatment gaps, increased health care costs and poorer outcomes. Early diagnosis and treatment access are imperative. There are no US studies of co-occurring oral diseases and mental illnesses in PLWHA. Assessment of treatment needs, self-management, and case management can inform improved referral and treatment outcomes. Studies have identified barriers to dental care in PLWHA, including ability to pay, dental anxiety, transportation, etc. Patients, HIV program directors, case managers and administrators are key stakeholders in understanding PLWHA use of dental and mental health services. Their referral success has not been assessed through traditional HIV surveillance. Factors for successful referral of PLWHA to mental health and dental services are understudied. Examining linkage factors as perceived by PLWHA, program directors and other staff, including the role of motivational Self-Determination Theory-based (SDT) mechanisms is needed. The proposed study will examine factors related to referrals of PLWHA to dental and mental health services and to describe the prevalence of comorbidities in 105 PLWHA, their self- management, and their perception of case management. All patients (with or without co-morbidities) will be assessed. The primary study outcome is keeping dental and/or mental health referral appointments. AIM 1: To examine referral linkage factors (social, biological, or behavioral) in those screened for 1) oral diseases only, 2) mental illness only, 3) both oral diseases and mental illness, or 4) neither (comparison group). Other assessments include 8 key informant interviews (KIIs), 2 focus groups (FGs) with 8-12 participants each and validated surveys. AIM 2: 2a) To describe the prevalence of comorbidities in a sample of PLWHA, the use of self-management strategies and their referral need based on screening and clinical data (periodontal inflammation via salivary biomarker IL-6 at baseline); 2b) To assess feasibility and obtain pilot data to inform a future motivation-based intervention targeting oral and mental health behavior in PLWHA. AIM 3: To examine health status at six months via patient screenings, clinical examination with salivary biomarkers, and a survey. Hypothesis: PLWHA screening positive for dental/mental comorbidities will keep fewer referral appointments than those not screening positive. This could be associated with SDT motivational indices for referral and to linkage factors. This innovative mixed-methods study will inform a needed evidence-base for patients, dental and mental health professionals and other stakeholders, as well as future studies (e.g., a randomized clinical trial) and potential interventions such as Motivational Interviewing strategies to maximize successful referrals.