Point-of-Care HIV Testing Uptake Similar in Dental Settings

Point-of-care tests (POCT) for HIV could be an effective way to engage patients in testing for HIV if they are targeted toward certain groups that may be missed otherwise. In a review published in Community Dentistry and Oral Epidemiology,¹ researchers found that uptake of POCTs was comparable in dental settings when compared with other non-specialized health settings, indicating its usefulness in encouraging testing.

An estimated 36 million people live with HIV worldwide with approximately 5.5 million living undiagnosed.² Interventions to encourage HIV testing have been conducted, including interventions with POCT for HIV. Although studies on POCT for HIV have been conducted in the past, there has been no review of the literature. This review aimed to identify what the core components of HIV testing are and what the barriers to successful interventions are.

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The researchers used Web of Science, MEDLINE via Ovid, Scopus, Cumulative Index to Nursing and Allied Health, and the Cochrane Library to conduct their search for studies. Additional grey literature was collected from the first 10 pages of Google Scholar and Google. Primary research studies that were qualitative, quantitative, or mixed methods interventions or were studies about POCT for HIV in dental settings in high income countries were included for this study. Studies that did not encompass what the aim of the review were excluded.

Data were extracted from all articles including number of HIV tests offered, number of HIV tests performed, number of reactive HIV test results, and associations with test uptake. Outcomes included core components of HIV testing interventions, HIV test uptake, factors associated with test uptake, and barriers and facilitators to testing for HIV in dental settings.

There were 28 studies included in the review, with 9 of them testing interventions in the dental setting. There were no studies that originated in Europe, with 23 coming from the US, 3 from Canada, and 2 from Australia.

There were 22,146 dental patients who were offered testing for HIV, of which 62.5% accepted. Finger prick POCT was offered to 5558 patients whereas the oral swab test was offered to 16,588, with patients offered the finger prick testing more willing to accept testing compared with the oral swab group (68.9% vs 60.3%).

Patients who were eligible for HIV testing were offered a test by their dentist 44.5% to 50.0% of the time compared with 97.9% of the time when a dedicated researcher delivered the intervention. POCT was accepted a mean of 62.5% of the time and uptake was between 5.6% and 97.6% in the studies. Patients who were Black or Hispanic, were female, and were aged less than 35 years were more likely to uptake HIV testing. Higher uptake was reported in studies who used a dedicated dental or research staff to conduct HIV testing.

The major barriers to HIV testing in dental settings included dentists not having enough experience with HIV, dentists who believed HIV was not a unique problem to them and therefore not as important for them to offer, a lack of time to conduct this testing, and the belief that stigma around HIV could negatively affect the relationship between the dentist and his patients.

Themes that were facilitators for HIV included the appreciation for the importance of testing for HIV, implementing the tests in hospital and community settings, offering testing for HIV in areas that are uniquely affected, and matching the intervention to the patients in the dental setting.

The review had some limitations. The studies included were of low or moderate quality and had small sample sizes. These studies were primarily conducted in high-income countries in North America, which could limit the understanding of these interventions in lower income countries or in countries in Europe.

The uptake of POCT for HIV offered in the dental setting was found to be comparable across both finger prick and oral swab tests when compared with POCTs offered in other non-specialized settings. Offering the tests in community clinics and having dedicated staff to conduct the testing could be a solution to encouraging testing uptake of HIV testing in dental patients.

References

1. Doughty J, Tran C, Santella AJ, et al. Point of care HIV testing in dental settings in high-income countries: a mixed-methods systematic review. Community Dent Oral Epidemiol. Published online June 1, 2024. doi:10.1111/cdoe.12963
2. Global statistics. HIV.gov. Updated November 23, 2023. Accessed June 2, 2024. https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics