Arab dentists' refusal to treat HIV positive patients: a survey of recently graduated dentists from three Arab dental schools

OBJECTIVE

To assess intended refusal of recent graduates from three Arab dental schools to treat HIV + patients and factors associated with this intention.

MATERIALS AND METHODS

In 2015, convenience samples of recent dental graduates were included from Libya, Egypt and the United Arab Emirates. Participants responded to a questionnaire assessing personal background, knowledge of oral manifestations and fluids transmitting HIV, perceived adequacy of training and self-efficacy to manage blood exposures, attitude to risk of infection, moral beliefs and willingness to treat HIV + patients. Logistic regression assessed factors associated with intended refusal to treat HIV + patients.

RESULTS

The overall response rate was 552/710 (77.8%), mean age = 23.7 years with 41.8% males. The mean (SD) scores for knowledge of oral manifestations and fluids transmitting HIV were 5.5 (1.3)/8 and 4.2 (1.7)/7. The mean (SD) scores for attitude to risk of infection and moral beliefs were 2.9 (1.0)/4 and 2 (0.9)/3, respectively. One-third of respondents indicated intention to refuse treating HIV + patients. Knowledge of body fluids transmitting HIV and moral beliefs were associated with lower odds of refusing to treat HIV + patients (OR = 0.86 and 0.38) whereas attitude indicating greater concern for risk of infection was associated with higher odds (OR = 1.54).

CONCLUSIONS

One third of dentists from three Arab dental schools indicated they would refuse to treat HIV + patients. Adequate knowledge and moral beliefs reflecting professional ethics were associated with lower odds of refusal counterbalancing the association with attitude indicating increased concern for risk of infection with implications for dentist education and training.

HIV Serostatus Disclosure and Engagement in Medical Care Among Predominantly Low Income but Insured African American Adults with HIV

More than half of persons living with HIV (PLWH) do not enter into or remain in continuous HIV medical care. Disclosure of HIV serostatus to social contacts may play an important role in successful engagement of PLWH with medical care. The effect of disclosure on medical care engagement was examined in a sample of African American PLWH (n = 262) recruited from community-based organizations as part of a peer community health worker initiative. At baseline assessment, many of the PLWH (46 %) reported they had not disclosed their serostatus to others. Engagement in medical care was assessed 45 and 90 days after enrollment. Participants who disclosed their HIV status were subsequently more likely to engage in HIV medical care (78 %) than persons who did not disclose their status (66 %), an effect that was confirmed in multiple logistic regression. The findings highlight disclosure as an important predictor of engagement in HIV medical care for PLWH.

HIV stigma: perceptions from HIV-positive and HIV-negative patients in a community dental clinic

Background. In the medical sense, stigma has been defined as the collection of negative attitudes and beliefs that are directed at people living with a particular condition or disease process. A cohort study was conducted to explore the HIV stigma that is perceived by HIV-positive individuals versus that perceived by the general population within a community-based dental clinic. Methods. Two separate and independent cross-sectional surveys, the Berger Stigma Scale and the Rutgers-Modified Berger Stigma Scale, were employed in order to analyze the stigma factors of an HIV-positive population versus an HIV-negative general population, respectively. The HIV stigma factors studied included personalized stigma, disclosure concerns, negative self-image, and concern with public attitudes. Results. The total stigma scale scores for the studied HIV-positive population were significantly lower than the total stigma scale scores for the studied HIV-negative population (P < 0.05). Conclusion. Interestingly, there is a misplaced expectation by the general population that HIV-positive individuals experience more stigma than the HIV-positive population in the clinic actually reported. Interventions to reduce HIV stigma should be an integral component of comprehensive care for all patients.

Dentists' and dental students' attitudes, knowledge, preparedness, and willingness related to treatment of people living with HIV/AIDS in China

OBJECTIVES

This study aims to assess the attitudes, knowledge, preparedness, and willingness of dentists and dental students to treat people-living-with-HIV/AIDS (PLWHA) in China, and to determine the factors associated with willingness to treat.

METHODS

We surveyed dentists and dental students in hospitals and dental schools in five regions in China with varying PLWHA prevalence. Survey questions covered demographics, as well as four categories regarding treating PLWHA: knowledge (scaled 0-1), attitude (scaled 1-4), preparedness (scaled 1-4), and willingness to treat (scaled 1-4). Composite scores for each category were calculated as weighted means. Confounder-adjusted regression analysis was performed to determine the factor(s) correlated with willingness to treat.

RESULTS

We collected 394 (84 percent) and 462 (90 percent) useable surveys from dentists and dental students respectively. Dentists' mean composite scores were 0.63 (poor knowledge), 2.1 (negative attitude), 2.8 (adequate preparedness), and 2.5 (neutral willingness). Students' mean composite scores were 0.64 (poor knowledge), 2.3 (negative attitude), 2.7 (adequate preparedness), and 2.6 (positive willingness). Forty-five percent of dentists and 59 percent of dental students had scores indicating positive willingness to treat. Attitude was the only factor consistently correlated with willingness to treat. Dentists and dental students scored low in all categories except for preparedness.

CONCLUSION

It is imperative that knowledge of HIV/AIDS and attitudes toward PLWHA be further improved during dental training to increase the access to and effectiveness of dental care of PLWHA in China and to enhance their quality of life.

Ethics, research and HIV: lessons learned- a workshop report

Assessing risk for transmission of a blood-borne pathogen requires the use of the hazard and risk model. Infection control is a system that uses a number of individual processes to eliminate or reduce the probability of a hazard occurring. Strategies employed to reduce risk should be rehearsed, used routinely, audited, reviewed, and the results shared. Continuing dental education has improved dental healthcare worker willingness to treat people living with HIV/AIDS (PLWHA) and has decreased negative attitudes and staff fears. Providing care for PLWHA during undergraduate dental school or dental hygiene programme is also associated with a greater willingness to treat. Whether by identifying suspect oral lesions or offering rapid screening tests in the dental setting for HIV, the dental team can play an important role in linkage to confirmatory diagnosis and care with the goal of reducing to zero the number of undiagnosed cases.

Chinese dental students' knowledge and attitudes toward HIV/AIDS

Background/purpose

Oral care is vital to human immunodeficiency virus (HIV)-positive individuals. As future dentists, it is pertinent that dental students have sufficient knowledge and a positive approach toward this disease. The purpose of this study was to assess HIV/AIDS-related knowledge and attitudes among clinical dental students in central China.

Materials and methods

This survey was conducted on 103 dental students in the final year of a 5-year program. A structured questionnaire with 50 questions examining their knowledge under various categories and 17 questions examining their attitudes toward the disease was employed.

Results

The survey was completed by 92.2% (95/103) of the students. The results revealed that more than half of the respondents demonstrated a good level of knowledge, although few exhibited an excellent level. The mean scores on knowledge was 79.41 ± 6.3 out of a maximum possible score of 100, and there was no significant difference regarding sex. Despite their good level of knowledge, the majority (93.68%) displayed a negative attitude (nonprofessional attitude) toward HIV/AIDS.

Conclusion

These findings might help to define strategies to improve the quality of education among Chinese dental students and suggests that there is a need to address student misconceptions and attitudes toward the disease.

Ethical decision making in dental education: a preliminary study

BACKGROUND

In terms of ethical decision making, every clinical case, when seen as an ethical problem, may be analyzed by means of four topics: medical indications, patient preferences, quality of life, contextual features. The aim of this study was to compare the performance of 4th year dental students on Ethical Decision Making before and after a course on ethics.

METHODS

Fourth year dental students (n = 37) from academic year 2013-2014 participated in the study. A 3-h lecture, which was about four topics approach to clinical ethical case analysis, was given to the students. The lecture was based on case scenarios related with dental ethics. After the completion of lectures,a case scenario was presented to the students to assess their ethical decision making abilities. At the end of the exam, four topics and ethical judgment were evaluated. Their performances on this examination were evaluated before and after lectures. Statistical evaluation was performed with the significance level set at p < 0.05.

RESULTS

A statistically significant difference was found between the means of four topics (p < 0.05). There was no statistically significant difference between the mean scores of judgment of ethical decision (p > 0.05). The mean total score of the students after the course was significantly higher than before course (67.5 and 54.4, respectively; p < 0.05).

CONCLUSION

More lectures should be implemented to the curriculum to increase the student awareness of ethical issues and to reach the ultimate goals of dental education.

Knowledge and Attitude of Faculty Members Working in Dental Institutions towards the Dental Treatment of Patients with HIV/AIDS

Background. Dentists have an ethical responsibility to provide treatment to HIV-infected patients, particularly because oral lesions are common among these patients. However, there are no official guidelines as to how to treat people living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA) or how to screen for potentially infectious people. Materials and Method. A descriptive cross-sectional questionnaire based study which assessed the knowledge and attitude of the faculty members towards the treatment of patients with HIV/AIDS was carried out in the Sudha Rustagi College of Dental Sciences, Faridabad, and Maulana Azad Institute of Dental Sciences, New Delhi. Results. The willingness to treat patients with HIV was found to be 86.0% among the faculty members in the present study. The majority (79%) of the faculty members thought that treating an HIV-positive patient is ethical responsibility of the dentist. There was a positive attitude (88.0%) among faculty members that routine dental care should be a part of the treatment of patients with HIV/AIDS. Conclusion. The level of knowledge regarding HIV and AIDS was acceptable in the present study. However, continuing dental education (CDE) programmes should be conducted on a regular basis for updating the knowledge level of the faculty members towards the dental treatment of patients with HIV/AIDS patients.

HIV-related stigma in the dental setting: a qualitative study

PURPOSE

To explore the experiences and expectations of HIV-related stigma in dental settings.

METHODS

This was a cross-sectional study of 60 HIV+ adult volunteers. We conducted audio-recorded interviews; responses to four open-ended questions were analyzed qualitatively for theme and content.

RESULTS

Twenty-seven participants (45%) reported ever having anticipated being judged, stigmatized or treated with disrespect in a dental setting due to HIV status. Thematic response categories included concerns about: (i) receiving humane and respectful treatment, (ii) being judged or stereotyped and (iii) giving HIV to the dentist. Regarding hesitancy to visit the dentist, subjects equally endorsed fear of the dentist (35%) and concerns about confidentiality and receiving humane treatment (35%).

CONCLUSION

HIV+ individuals encounter many fears and concerns related to dental care; fear of the dentist and concerns about confidentiality and receiving humane treatment appear to be central issues. Dental providers should be aware of and better manage these issues.

A retrospective case-control analysis of the outpatient expenditures for western medicine and dental treatment modalities in CKD patients in Taiwan

BACKGROUND

To determine if expenditures for dentistry (DENT) correlate with severity of chronic kidney disease (CKD).

METHODS

A total of 10,457 subjects were enrolled from January 2008 to December 2010, divided into three groups: healthy control (HC) group (n = 1,438), high risk (HR) group (n = 3,392), and CKD group (n = 5,627). Five stages were further categorized for the CKD group. OPD utilization and expenditures for western medicine (WM), DENT, and TCM (traditional Chinese medicine) were analyzed retrospectively (2000-2008) using Taiwan's National Health Insurance Research Database. Three major areas were analyzed among groups CKD, HR and HC in this study: 1) demographic data and medical history; 2) utilization (visits/person/year) and expenditures (9-year cumulative expenditure, expenditure/person/year) for OPD services in WM, DENT, and TCM; and 3) utilization and expenditures for dental OPD services, particularly in dental filling, root canal and periodontal therapy.

RESULTS

OPD utilization and expenditures of WM increased significantly for the CKD group compared with the HR and HC groups, and increased steadily along with the severity of CKD stages. However, overall DENT and TCM utilization and expenditures did not increase for the CKD group. In comparison among different CKD stages, the average expenditures and utilization for DENT including restorative filling and periodontal therapy, but not root canal therapy, showed significant decreases according to severity of CKD stage, indicating less DENT OPD utilization with progression of CKD.

CONCLUSIONS

Patients with advanced CKD used DENT OPD service less frequently. However, the connection between CKD and DENT service utilization requires further study.

Knowledge of and attitudes towards HIV/AIDS: a survey among dental students in Ajman, UAE

AIM

Encounters between dentists and patients with HIV/AIDS are bound to rise due to increased prevalence and emerging new treatments. This study assessed dental students' knowledge about transmission and oral manifestations of HIV/AIDS, and their attitudes towards patients regarding obligations to treat.

METHODS

Out of 109 students in 4 years of a 6-year dental undergraduate program, 106 responded to a questionnaire on knowledge of and attitudes towards HIV/AIDS. Knowledge and attitude scores were analyzed with Kruskal-Wallis one-way anova and the gender differences with the Wilcoxon signed-rank test.

RESULTS

The median score for students' overall knowledge was 39.5 (67%; maximum possible 59). The median knowledge scores for males and females were 38 and 40 respectively, although the difference was not statistically significant. The knowledge levels in Year 4 (42.5 ± 4.7), Year 3 (44 ± 6.5), and Year 2 (42 ± 5.8), were similar but significantly higher than in Year 1 (33 ± 7.9; P < 0.01). The median attitude score was 14 out of 24, with no significant differences within genders and years of study. Although the level of knowledge of the senior students was higher than that of the first years, the negative attitudes remained largely unchanged.

CONCLUSIONS

Appropriate educational programs may alter the misconceptions and the negative attitudes.

Retention of people living with HIV/AIDS in oral health care

OBJECTIVE

We identified factors associated with retention in oral health care for people living with HIV/AIDS (PLWHA) and the impact of care retention on oral health-related outcomes.

METHODS

We collected interview, laboratory value, clinic visit, and service utilization data from 1,237 HIV-positive patients entering dental care from May 2007 to August 2009, with at least an 18-month observation period. Retention in care was defined as two or more dental visits at least 12 months apart. We conducted multivariate regression using generalized estimating equations to explore factors associated with retention in care.

RESULTS

In multivariate analysis, patients who received oral health education were 5.91 times as likely (95% confidence interval 3.73, 9.39) as those who did not receive this education to be retained in oral health care. Other factors associated with care retention included older age, taking antiretroviral medications, better physical health status, and having had a dental visit in the past two years. Patients retained in care were more likely to complete their treatment plans and attend a recall visit. Those retained in care experienced fewer oral health symptoms and less pain, and better overall health of teeth and gums.

CONCLUSIONS

Retention in oral health care was associated with positive oral health outcomes for this sample of PLWHA. The strongest predictor of retention was the receipt of oral health education, suggesting that training in oral health education is an important factor when considering competencies for new dental professionals, and that patient education is central to the development of dental homes, which are designed to engage and retain people in oral health care over the long term.

Increasing access to oral health care for people living with HIV/AIDS in rural Oregon

Access to oral health care for people living with HIV/AIDS is a severe problem. This article describes the design and impact of an Innovations in Oral Health Care Initiative program, funded through the Health Resources and Services Administration HIV/AIDS Bureau's Special Projects of National Significance (SPNS) program, that expanded oral health-care services for these individuals in rural Oregon. From April 2007 to August 2010, 473 patients received dental care (exceeding the target goal of 410 patients) and 153 dental hygiene students were trained to deliver oral health care to HIV-positive patients. The proportion of patients receiving oral health care increased from 10% to 65%, while the no-show rate declined from 40% to 10%. Key implementation components were leveraging SPNS funding and services to create an integrated delivery system, collaborations that resulted in improved service delivery systems, using dental hygiene students to deliver oral health care, enhanced care coordination through the services of a dental case manager, and program capacity to adjust to unanticipated needs.

Knowledge and attitudes towards HIV/AIDS amongst Kuwait University dental students

The HIV and AIDS have emerged as complex health threats to the world population. As future dentists, it is pertinent that the dental students have sufficient knowledge and a positive approach towards the disease. Accordingly, the aim of this study was to assess the HIV/AIDS related knowledge and attitudes amongst clinical dental students at Kuwait University. A cross-sectional survey was conducted amongst the clinical dental students using a structured questionnaire with 60 questions to examine their knowledge under various categories and 13 questions to examine their attitudes towards the disease. The survey revealed that almost 58% of the respondents demonstrated a high level of knowledge (mean score: 45.23 ± 4.35 SD). Majority of the students (63.6%) expressed negative attitude (mean score: 5.36 ± 2.56 SD). The mean knowledge score of the fifth year dental students was significantly higher (P = 0.022) than that of the final year dental students regarding the knowledge of virus and disease process. However, no significant difference was observed with respect to other knowledge categories. Despite their high level of knowledge, the majority displayed a negative attitude towards HIV/AIDS. Hence, the findings imply that there is a need to address, more clearly, the students' misconceptions and attitudes towards the disease.

Dental school deans' and dentists' perceptions of infection control and HIV/AIDS patient care: a challenge for dental education in Mexico

HIV/AIDS patients face unique oral diagnostic and treatment challenges. The aim of this investigation among dental school deans (DSD) and graduate school applicants (GSA) who had qualified from 30 different dental schools was to assess their perceptions on dental education relevant to infection control (IC) and HIV/AIDS patient care. The questionnaire included Likert-type scale evaluations of agreement with statements. Of 158 questionnaires, 23 DSD (68% response rate), and 123 GSA (100% response rate) returned valid questionnaires. Fifteen (65%) DSD and 89 (72%) GSA ranked as "very strong" their perception that infection control prevents the transmission of blood borne viruses. However, the perception prevailed, among DSD and GSA, that HIV infection was a "very strong" to "strong" occupational hazard. Special reprocessing of instruments used on HIV patients was frequently reported. Many considered "very strong" to "strong" that HIV/AIDS patients must be treated in specialized clinics, and nearly half (48%) of the DSD and one third (35%) of the GSA stated that their school does refer HIV/AIDS patients to dental treatment in specialized clinics. These results indicate that many dental schools in Mexico must provide better education on IC and HIV/AIDS patient care to enhance attitudes toward HIV/AIDS patients.

The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population

Perceived stigma in clinical settings may discourage HIV-infected individuals from accessing needed health care services. Having good access to care is imperative for maintaining the health, well being, and quality of life of persons living with HIV/AIDS (PLWHAs). The purpose of this prospective study, which took place from January 2004 through June 2006, was to evaluate the relationship between perceived stigma from a health care provider and access to care among 223 low income, HIV-infected individuals in Los Angeles County. Approximately one fourth of the sample reported perceived stigma from a health care provider at baseline, and about one fifth reported provider stigma at follow up. We also found that access to care among this population was low, as more than half of the respondents reported difficulty accessing care at baseline and follow up. Perceived stigma was found to be associated with low access to care both at baseline (odds ratio [OR] = 3.29; 95% confidence interval [CI] = 1.55, 7.01) and 6-month follow up (2.85; 95% CI = 1.06, 7.65), even after controlling for sociodemographic characteristics and most recent CD4 count. These findings are of particular importance because lack of access or delayed access to care may result in clinical presentation at more advanced stages of HIV disease. Interventions are needed to reduce perceived stigma in the health care setting. Educational programs and modeling of nonstigmatizing behavior can teach health care providers to provide unbiased care.