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

HIV/AIDS-Associated Knowledge and Attitudes towards Treating Disadvantaged Communities among Pre-Community-Based Dental Education Dental Students in the U.S

This study examines HIV/AIDS-associated knowledge and attitudes towards treating disadvantaged communities among predoctoral dental students in U.S. dental schools who have not yet commenced their Community-Based Dental Education (CBDE) training. It also compares the difference in the knowledge and attitudes between students with reported community engagement with PLWHA and those without. Our study comprised 89 predoctoral dental students within their D1-D3 years of dental school who had not yet initiated their Community-Based Dental Education (referred to as pre-CBDE dental students). Their responses were collected via an online survey. The participants were 68% females, 94% heterosexual, and with a mean age (years) of 25.9 ± 3.5 SD. The majority (62%) were in their first (D1) and second (D2) years of dental education. Of the thirty knowledge questions, only five received a minimum of 90% correct responses. Similarly, we found no statistical differences in most of the knowledge/attitude sections between those with and without prior PLWHA exposure. Encouragingly, 90% of our participants reported prior experience working with disadvantaged communities. Early community engagement fosters a sense of professional responsibility towards administering dental care to disadvantaged communities and we propose that it must be encouraged among aspiring dental school students.

Use of dental care services among adolescents living with HIV on antiretroviral treatment in Kampala, Uganda: a cross-sectional study

OBJECTIVE

The primary purpose of this study was to assess the prevalence and socio-behavioral determinants of ever-use of dental care services among adolescents aged 10-18 years, living with HIV, on Antiretroviral treatment (ART), and attending selected HIV clinics in Kampala, Uganda.

METHODS

A cross-sectional study was carried out between March and September 2020. The study conveniently recruited 154 adolescents between 10 and 18 years old from 4 specific HIV clinics in Kampala. Andersen's behavioral model guided the selection of variables, with the ever-use of dental care services as the outcome and predisposing, enabling, need-related factors and personal dental health practices as exposure variables. Data were analyzed using Fischer's exact test for cross-tabulation and modified Poisson regression for multivariate analysis.

RESULTS

The prevalence of ever-use of dental care services was 12.3%. The adolescents aged 14-18 had higher odds of using dental care services (Prevalence ratio (PR) of 3.35 than those aged 10-13 years. Fear of the spread of HIV was negatively associated with ever-use of dental care services (PR of 0.06). Participants who were afraid of going to the dentist had higher odds of using dental care services (PR of 2.98) than those not afraid. Failure to receive dental treatment because it was not part of the medical appointment had a positive association with the ever-use of dental care services (PR of 4.50). Those who were satisfied with their dental condition had lower odds of using dental care services. The bad oral odor was positively associated with the ever-use of dental care services (PR of 2.80). The use of soap for toothbrushing was positively associated with the ever-use of dental care services (PR of 2.51).

CONCLUSION

The study found a low frequency of dental care use among HIV-infected adolescents in Kampala, Uganda, with age being a predisposing factor. Enabling factors included fear of HIV spread, medical-dental appointment incoordination, and satisfaction with the dental condition and bad oral odor while under personal dental health practices. The use of soap for toothbrushing was an important association with dental care. Nevertheless, these study results cannot be generalized to the entire HIV adolescent population in Uganda.

Use of dental care services among adolescents living with HIV on Antiretroviral Treatment in Kampala, Uganda: a cross-sectional study

Objective

The main purpose of this study to assess the prevalence and socio-behavioural determinants of ever-use of dental care services among the adolescents aged 10-18 years, living with HIV on Antiretroviral treatment (ART), attending selected HIV clinics in Kampala, Uganda.

Methods

A cross-sectional study was carried out between March and September 2020. The study conveniently recruited 154 adolescents between 10-18 years from 4 specific HIV clinics in Kampala. The Andersen's behavioral model guided the selection of variables in terms of ever use of dental care services as the outcome- and predisposing, enabling, need related factors and dental health related behavior as exposure variables. Data was analyzed using Fischer's exact test for cross-tabulation and modified Poisson regression for multivariate analysis.

Results

The prevalence of ever-use of dental care services was 12.3%. The adolescents aged 14-18 years were more likely to have used dental care services (Prevalence ratio (PR) of 3.35 (Confidence Interval (CI) 1.48-7.59) than those aged 10-13 years. Fear of spread of HIV was negatively associated with ever-use of dental care services (PR of 0.06 and CI of (0.01-0.44). Participants who were afraid of going to the dentist were more likely to have ever used dental care services (PR of 2.98 and CI of 1.41-6.30) than those not afraid. Failure to receive dental treatment because it was not part of the medical appointment had a positive association with ever-use of dental care services (PR of 4.50 (CI: 1.14-17.80). Those who were satisfied with their dental condition were less likely to have ever-used dental care services (PR of 0.21 and CI of (0.05-0.94). Bad oral odor was positively associated with ever-use of dental care services with a PR of 2.80 and CI of 1.19-6.60. Use of soap for toothbrushing was positively associated with ever-use of dental care services (PR of 2.51, CI of 1.47-4.28).

Conclusion

The study found low frequency of dental care use among HIV infected adolescents in Kampala, Uganda, with age being a predisposing factor. Enabling factors included fear of HIV spread, dental appointment failure, and satisfaction with dental condition and bad oral odor while under personal oral hygiene and dental practices, use of soap for toothbrushing was an important association of use of dental care.

Effect of Community Support Agents on Retention of People Living With HIV in Pre-antiretroviral Care: A Randomized Controlled Trial in Eastern Uganda

BACKGROUND

Over 50% of people living with HIV (PLHIV) in sub-Saharan Africa are lost to follow-up between diagnosis and initiation of antiretroviral treatment during pre-antiretroviral (pre-ARV) care. The effect of providing home counseling visits by community support agents on 2-year retention in pre-ARV care was evaluated through a randomized controlled trial in eastern Uganda.

METHODS

Four hundred newly screened HIV-positive patients were randomly assigned to receive posttest counseling alone (routine arm) or posttest counseling and monthly home counseling visits by community support agents to encourage them go back for routine pre-ARV care (intervention arm). The outcome measure was the proportion of new PLHIV in either arm who attended their scheduled pre-ARV care visits for at least 6 of the anticipated 8 visits in the first 24 months after HIV diagnosis. The difference between the 2 study arms was assessed using the χ and T tests. Mantel-Haenszel Risk Ratios and multivariate logistic models were used to assess the adjusted effect of the intervention on the outcome.

RESULTS

In all models generated, participants receiving monthly home counseling visits were 2.5 times more likely to be retained in pre-ARV compared with those in standard care over a period of 24 months (adjusted risk ratio, 2.5; 95% confidence interval: 2.0 to 3.0).

CONCLUSION

Monthly follow-up home visits by community workers more than doubled the retention of PLHIV in pre-ARV care in rural Uganda and can be applicable in similar resource-poor settings.

Barriers and facilitators to dental care among HIV-Infected adults

Oral health problems can significantly compromise HIV-infected individuals' general health and well-being, yet many of them experience an unmet need for oral care. The barriers and facilitators of obtaining dental care in a sample of HIV-infected adults, all of whom were eligible for Ryan White Part A funding for their treatment, were investigated through qualitative interviews with HIV-positive individuals who had not received dental services in the prior 12 months (n = 44). Identified barriers were as follows: (1) dental anxiety and fear, (2) cumbersome administrative procedures, (3) long waits at the dental office, (4) problem focused care-seeking behavior, (5) transportation difficulties, (6) dentists' reluctance to treat people like them, and (7) psychological issues. Identified facilitating factors were as follows: (1) coverage for dental care, (2) being treated with respect and acceptance, and (3) having an assigned case manager or social worker. Many of the barriers uncovered in this qualitative study can be addressed and overcome by case management services, but other approaches are needed to address the additional psychological and stigma-related factors that are impeding access to oral healthcare in this population.

Effect of Nadir CD4+ T cell count on clinical measures of periodontal disease in HIV+ adults before and during immune reconstitution on HAART

BACKGROUND

The contribution of HIV-infection to periodontal disease (PD) is poorly understood. We proposed that immunological markers would be associated with improved clinical measures of PD.

METHODS

We performed a longitudinal cohort study of HIV-infected adults who had started highly active antiretroviral therapy (HAART) <2 years. PD was characterized clinically as the percent of teeth with ≥ 1 site with periodontal probing depth (PPD) ≥ 5.0mm, recession (REC) >0mm, clinical attachment level (CAL) ≥ 4.0mm, and bleeding on probing (BOP) at ≥ 4 sites/tooth and microbiologically as specific periodontopathogen concentration. Linear mixed-effects models were used to assess the associations between immune function and PD.

RESULTS

Forty (40) subjects with median 2.7 months on HAART and median nadir CD4+ T-cell count of 212 cells/μl completed a median 3 visits. Over 24 months, CD4+ T-cell count increased by a mean 173 cells/µl (p<0.001) and HIV RNA decreased by 0.5 log10 copies/ml (p<0.001); concurrently, PPD, CAL and BOP decreased by a mean 11.7%, 12.1%, and 14.7% respectively (all p<0.001). Lower nadir CD4+ T-cell count was associated with worse baseline REC (-6.72%; p=0.04) and CAL (9.06%; p<0.001). Further, lower nadir CD4+ T-cell count was associated with a greater relative longitudinal improvement in PPD in subjects with higher baseline levels of Porphyromonas gingivalis (p=0.027), and BOP in subjects with higher baseline levels of Porphyromonas gingivalis or Treponema denticola (p=0.001 and p=0.006 respectively). Longitudinal changes from baseline in CD4+ T-cell count and level of HIV RNA were not independently associated with longitudinal changes in any clinical markers of PD.

CONCLUSION

Degree of immunosuppression was associated with baseline gingival recession. After HAART initiation, measures of active PD improved most in those with lower nadir CD4+ T-cell counts and higher baseline levels of specific periodontopathogens. Nadir CD4+ T-cell count differentially influences periodontal disease both before and after HAART in HIV-infected adults.