Study: Hygienists could conduct rapid HIV testing

Recent literature has shown that dental offices can play an important role in screening for various medical conditions such as hypertension and diabetes. Now it seems testing for the human immunodeficiency virus (HIV) could be added to the list.

Dental hygienists who receive additional training in HIV prevention counseling and diagnostic testing may be appropriate professionals to conduct rapid HIV testing, according to a new study in the International Journal of Dental Hygiene (April 10, 2013).

Expanded rapid HIV testing initiatives are needed outside the routine medical setting to normalize HIV testing in the U.S., and the dental setting is a logical choice as almost two-thirds of Americans visit their dentists on a regular basis, the study authors noted.

Lead author Anthony Santella, PhD, from the Sydney Medical School at the University of Sydney, told DrBicuspid.com that, to the best of his knowledge, the only other study that examined this topic among dental hygienists was in Italy.

And although the role of dentists and dental hygienists in chronic disease screening has been debated over the past few years, a study with a national representative sample of dental hygienists has not been conducted and published in the U.S., he noted.

"The overarching goal of this study was to determine knowledge and attitudes to HIV and willingness to conduct rapid HIV testing among dental hygienists in the U.S.," explained Santella. "We hope by exploring these factors we can provide public health policy insight and evidence on the possible expansion of rapid HIV testing into the dental setting."

Some stigma remains

The study authors conducted a cross-sectional survey of 634 practicing dental hygienists and senior dental hygiene students who were recruited by phone using a purchased list of dentists practicing in New York City, through in-person recruitment efforts at local continuing education symposia, and through New York City area dental hygiene schools.

After a thorough literature review, Santella and his colleagues chose two survey instruments to measure knowledge of HIV and attitudes toward people with HIV. The knowledge survey was adapted from the HIV Knowledge Questionnaire initially designed for populations with low literacy levels. The final survey used included 13 questions assessing knowledge. The HIV attitudes questions were derived from a scale originally developed for psychiatry residents.

Inclusion criteria for the study included being a U.S. resident and a practicing dental hygienist. The survey was conducted between September 2011 and January 2012.

Here are some of the key results:

• Given a test of 13 questions on HIV knowledge, the mean test score in the group was 10.5.
• Out of a total of 634 respondents, 475 (74.9%) achieved a score of 75% or higher on the knowledge test, and these individuals were divided into a group titled high scorers; the remaining 25.1% of individuals with scores under 75% were placed into the low-scorers group.
• Those with high test scores were more likely than those with low test scores to feel comfortable about counseling about sexual HIV prevention methods.
• Those with high test scores were also less likely than those with low test scores to feel that patients with HIV should be quarantined to prevent the spread of infection and to feel that dental hygiene students should be allowed to opt out of being able to treat patients with HIV.
• A majority (58.53%) of the high-scoring group did indicate that they would be willing to conduct HIV rapid testing.

Santella told DrBicuspid.com that he and his colleagues were surprised to find that even with a well-educated sample of 634 dental hygienists, many carried some level of stigma or negative attitude toward people with HIV.

"For example, even among dental hygienists with high knowledge of HIV, they felt people living with HIV should be quarantined to stop the spread of infection and that dental hygiene students should be able to opt out of treating patients with HIV," he noted.

Dental offices located in areas where HIV surveillance reports suggest there are significant cases of undiagnosed HIV infection and/or late diagnosis should consider partnering with their local or state health department and sexual health clinics to offer rapid HIV testing, Santella added.

Many dental offices already offer chronic disease screening tests, and HIV testing can potentially be added to the mix of test offerings, he said.

"These findings demonstrate that dental hygienists' knowledge is associated with comfort levels for HIV counseling and that the dental setting may be a site to provide HIV testing and counseling," the authors concluded. "Administration of HIV testing in the dental setting may allow patients who might otherwise not get tested to do so and receive appropriate medical treatment."