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.
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.