Point of care HIV testing in dental settings in high-income countries: A mixed-methods systematic review.

OBJECTIVES: Expanding HIV testing beyond specialized services has been a key strategic approach to eliminating the transmission of HIV. In recent years, dental settings have been identified as offering an opportunity for delivering point of care HIV testing (POCT) interventions. Intervention components and implementation strategies have varied across studies and there is uncertainty about the prevalence of undiagnosed HIV in the dental patient population. Therefore, this systematic review aimed to synthesize the HIV testing outcomes of intervention studies, identify the core components of POCT interventions implemented in dental settings; and understand the barriers and facilitators to intervention implementation. METHODS: A mixed-methods systematic review was undertaken. Two authors reviewed abstracts and full papers for inclusion and appraised the studies using the Mixed Methods Appraisal Tool. A convergent integrated mixed methods study design underpinned the synthesis. Outcomes were presented using descriptive statistics. Intervention components were mapped to the Template for Intervention Description and Replication (TIDieR) checklist. Barriers and facilitators were described using a narrative thematic analysis. RESULTS: POCT was offered to 22 146 dental patients, 62.5% accepted POCT. Intervention studies that reported higher uptake of testing utilized a dedicated dental or researcher staff member to provide testing, integrated testing and provided results within the routine dental appointment and adopted a provider-initiated universal approach to offering testing. Six themes emerged that were pertinent to the barriers and facilitators to HIV testing in dental setting. CONCLUSIONS: POCT uptake in dental settings was comparable with other non-specialized health settings. Key to the operationalization of the intervention were perceptions about its value and relevance to the dental patient population, attitudes toward the intervention, logistical barriers to its implementation, the risk of HIV testing stigma to the patient-practitioner relationship and maximising the fit of the intervention within the constraints of the dental setting.

The potential role of dentists in HIV screening.

Recent evidence suggests there is a role for the dental team, particularly dentists, in offering chairside HIV screening to patients during dental appointments. HIV is no longer a death sentence with early diagnosis and effective treatment contributing to a good prognosis. Despite the availability of both venipuncture diagnostic and rapid saliva/finger prick screening tests for HIV infection, 25% of people living with HIV in the United Kingdom are undiagnosed and remain at risk of transmitting their infection if having unprotected sex. This paper highlights the international evidence that supports dentists' willingness to conduct HIV screening and dental patient acceptance, and explores whether this is an opportunity or a step too far.

Australian dentists' perspectives on rapid HIV testing.

BACKGROUND: Fourteen per cent of people living with HIV in Australia, as in other countries, are not aware of their infection or their infective status. Dentists have the necessary expertise and are well-placed for access by those sections of the population who would not normally access screening for HIV. METHODS: A national cross-sectional online survey of 532 Australian dentists was conducted during the period June to October 2013. We surveyed dentists' understanding and willingness to undertake rapid HIV testing (RHT). RESULTS: The majority of respondents (65.1%) believed that RHT was needed in dental clinics, with approximately two-thirds of respondents indicating that RHT should be made available immediately. If RHT was to be undertaken in a dental setting, 51.1% of dentists thought that it should be conducted on saliva only, as opposed to blood or blood/saliva. Only 21.9% of dentists would currently be comfortable advising a patient of a reactive (i.e. positive) result indicative of HIV infection, with male dentists (26.1% comfortable) more comfortable than female dentists (17.5% comfortable) (p = 0.009). CONCLUSIONS: The majority of respondents were willing to provide RHT in their community settings. However, our data indicate that dentists would need additional training in HIV medicine, test administration and giving reactive results.

Dental hygienists' knowledge of HIV, attitudes towards people with HIV and willingness to conduct rapid HIV testing.

OBJECTIVES: To normalize rapid human immunodeficiency virus (HIV) testing in the United States, expanded rapid HIV testing initiatives are needed outside the routine medical setting. The dental setting is a logical choice as almost two-thirds of Americans regularly see a dental provider each year. This study was aimed to determine the dental hygienists' knowledge of HIV, attitudes towards people living with HIV and willingness to conduct rapid HIV testing. METHODS: A national cross-sectional survey of practicing dental hygienists and senior dental hygiene students were recruited using state dental hygiene associations, email LISTSERVS, dental hygiene programmes and continuing education conferences (n = 634). RESULTS: The mean knowledge score was 10.5/13. High versus low test-scorers (75% of test questions or more answered correctly versus less than 75% answered correctly) did differ in their comfort level in counselling about sexual HIV prevention methods (P = 0.03) and comfort level in working with medically compromised patients (P = 0.04). CONCLUSION: Dental hygienists, with additional training in HIV prevention counseling and diagnostic testing, may be an appropriate profession to conduct rapid HIV testing.