HIV Testing in Dental Care Settings

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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.