Identifying Factors to Improve Dental and Mental Health Care among People with HIV

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Project Summary Identifying Factors to Improve Dental and Mental Health Care among People with HIV Impaired oral health and psychiatric disorders, including substance use, disproportionally impact people with HIV and AIDS (PWH). Conditions such as dental caries, salivary gland disease, ulcers, periodontitis, leukoplakia, and candidiasis are associated with HIV and can negatively impact quality of life. Depression, anxiety, substance use and other psychiatric disorders in PWH are also associated with more dental problems and unmet oral health needs. In addition, patient, provider, and system barriers interfere with the receipt of oral health care for PWH. HIV care, behavioral health care, and dental care are largely siloed, making it difficult for different health care clinics and different professionals to work together to provide coordinated care. There is great need to investigate further how individual and system-level barriers, behavioral health, and oral health intersect for PWH. In response to RFA-DE-23-002, this proposed project will conduct biannual assessments over two years of 400 PWH, from the Providence/Boston Center for AIDS Research HIV clinics, to identify modifiable individual and system-level barriers and facilitators for engagement and adherence in oral, HIV, and behavioral health care. Associations of longitudinal changes in oral, behavioral, and HIV symptoms and their relationships with barriers and facilitators will also be examined. In addition, in-depth interviews with 40 PWH from the longitudinal study, and 20 health care workers (from dental, behavioral, and HIV clinical settings) will provide further details on the nature of the barriers and facilitators to care, and suggest opportunities for improvement. Using this combined quantitative and qualitative data, strategies will be selected for clinic-based programs to improve oral and behavioral health care among PWH. Member checking, also known as participant validation, will examine the feasibility and acceptability of the selected strategies and actions through focus groups with 20 PWH from the longitudinal study and 10 health care workers from dental, behavioral, and HIV clinical settings. This will be one the largest, in-depth, prospective assessments to date of oral health among PWH that assesses behavioral health and other factors that directly influence oral health outcomes. These results will directly inform a research agenda beyond this study to improve oral and behavioral health among PWH.