PS11-003 Minority AIDS Research Initiative

描述(由申请人提供)：本提案响应了RFA-PS-11-003，少数民族艾滋病毒/艾滋病研究倡议(MARI)中列出的第5类--“卫生服务研究，以评估基于牙科、基于药房或其他非传统场所的艾滋病毒检测的可行性，以及在服务不足的社区中与护理机会的联系”，以在黑人和西班牙裔社区以及黑人和西班牙裔研究人员中进行艾滋病毒/艾滋病流行病学和预防研究。最近引入的艾滋病毒快速检测为促进艾滋病毒感染的早期诊断提供了一种特别有希望的筛查方法。2006年9月，美国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机构的优先事项。2008年12月，美国医师学会和艾滋病毒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毒检测。疾控中心、全国社区卫生中心协会和各州牙科协会组织的几次全国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诊所提供艾滋病毒快速检测。然而，尽管取得了这些进展，但目前几乎没有数据来说明提供此类服务的可行性。一个特别令人感兴趣的领域是，患者不希望在牙科保健环境中获得艾滋病毒检测，因此即使提供了这种服务，也可能不会接受。这一直是牙医在考虑在牙科保健环境中提供艾滋病毒检测时的一个担忧。为了满足这种对信息的需求，我们建议探索患者对口腔HIV快速检测在牙科护理环境中的观点。我们将结合患者访谈、牙科记录审查以及与牙医和牙科卫生师的定性访谈，1)确定患者在牙科护理环境中接受口腔HIV快速检测的比率，2)描述患者报告在牙科护理环境中接受或拒绝口腔HIV快速检测的原因，以及3)描述牙科医生和牙科卫生师对在牙科护理环境中提供和进行口腔HIV快速检测的态度。这项研究收集的数据将用于向公共卫生官员、牙科保健专业人员、政策制定者和研究人员通报与患者在牙科保健环境中接受口腔快速艾滋病毒检测相关的因素。这项研究还将有助于确定在牙科保健环境中最倾向于接受艾滋病毒快速检测的环境和/或患者群体，并将提供与资源分配相关的结果。拟议的项目将是位于佛罗里达州迈阿密-戴德县的迈阿密·米勒大学医学院、杰西·特里斯社区卫生中心和关怀资源公司之间的合作。玛格丽特·佩雷拉博士是迈阿密大学米勒医学院流行病学和公共卫生的多米尼加裔美国助理教授，她将担任首席研究员，并将由流行病学和公共卫生教授丽莎·梅奇博士指导，她在NIH和CDC资助的艾滋病毒预防和护理研究方面拥有17年以上的经验。 公共卫生相关性：公共卫生相关性：艾滋病毒快速检测的广泛使用使感染者能够得到早期诊断，从而有可能减少死亡和疾病。这是将人们与护理联系起来并减少艾滋病毒进一步传播的第一步。在这一倡议中，牙科保健环境中的快速艾滋病毒检测可能会发挥关键的、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，艾滋病毒快速检测面临几个障碍，包括缺乏报销、未知的患者接受度以及未知的提供者提供这项服务的意愿和能力。这项研究将提供有关在牙科保健环境中广泛实施艾滋病毒筛查的机会和障碍的关键信息，涉及患者的接受度以及牙医和牙齿卫生师在提供检测方面的经验。

DESCRIPTION (provided by applicant): This proposal responds to the category number 5 - "Health Services Research to Assess Feasibility of Dental-based, Pharmacy-based, or other Non-traditional Venue-based HIV Testing and Linkage to Care Opportunities in Underserved Communities" listed in the funding announcement RFA-PS-11-003, Minority HIV/AIDS Research Initiative (MARI) to Build Capacity in Black and Hispanic Communities and Among Black and Hispanic Researchers to Conduct HIV/AIDS Epidemiologic and Prevention Research. 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. One area of particular interest is that patients do not expect to be offered HIV testing in the dental care setting, and therefore may not accept such services if offered. This has been a concern for dentists in considering offering HIV testing in the dental care setting. To fill this need for information, we propose to explore patients' perspectives about oral HIV rapid testing in the dental care setting. We will conduct a combination of patient interviews, dental record reviews, and qualitative interviews with dentists and dental hygienists to 1) determine the rate at which patients accept an oral HIV rapid test in the dental care setting when offered by a dentist or dental hygienist, 2) describe the reasons patients report for accepting or rejecting an offer of an oral HIV rapid test in the dental care setting, and 3) describe dentists' and dental hygienists' attitudes toward offering and conducting oral HIV rapid testing in the dental care setting. The data collected in this study will be used to inform public health officials, dental care professionals, policymakers and researchers about factors associated with patients' acceptance of oral rapid HIV testing in the dental care setting. The study will also help to identify settings and/or groups of patients most inclined to accept HIV rapid testing in the dental care setting and will provide findings relevant to resource allocation. The proposed project will be a collaboration among the University of Miami Miller School of Medicine, the Jessie Trice Community Health Center, and Care Resource, Inc., all in Miami- Dade County, Florida. Dr. Margaret Pereyra, a Dominican-American Assistant Professor of Epidemiology and Public Health at the University of Miami Miller School of Medicine, will serve as Principal Investigator and will be mentored by Dr. Lisa Metsch, Professor of Epidemiology and Public Health, with over 17 years of experience in conducting NIH and CDC-funded HIV prevention and care research. PUBLIC HEALTH RELEVANCE: Relevance to Public Health Widespread use of rapid HIV 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. Rapid HIV testing in the dental care setting could play a critical, readily-overlooked role in this initiative. HIV screening in dental care settings could also enhance integration of oral and medical 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 with regards to patient acceptance and dentists' and dental hygienists experiences in providing testing.