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

IF 1.8 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE Community dentistry and oral epidemiology Pub Date : 2024-06-01 DOI:10.1111/cdoe.12963

J. Doughty, C. Tran, A. J. Santella, R. Fitzgerald, F. Burns, Stephen Porter, Richard G. Watt

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Abstract

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.

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高收入国家牙科环境中的 HIV 检测点：混合方法系统综述。

目标：将艾滋病检测扩展到专业服务之外一直是消除艾滋病传播的关键战略方法。近年来，牙科环境被认为是提供护理点 HIV 检测（POCT）干预的一个机会。不同研究中的干预内容和实施策略各不相同，而且在牙科患者人群中未确诊的 HIV 感染率也存在不确定性。因此，本系统综述旨在综合干预研究的艾滋病检测结果，确定在牙科环境中实施POCT干预的核心内容，并了解干预实施的障碍和促进因素：方法：采用混合方法进行了系统综述。两位作者对论文摘要和全文进行了审查，并使用混合方法评估工具对研究进行了评估。综合研究采用了聚合综合混合方法研究设计。研究结果采用描述性统计。干预措施的组成部分与干预措施描述和复制模板（TIDieR）核对表相对应。采用叙述性主题分析法对障碍和促进因素进行了描述：向 22 146 名牙科患者提供了 POCT，其中 62.5% 接受了 POCT。报告检测接受率较高的干预研究使用了专门的牙科或研究人员来提供检测，在常规牙科预约中整合检测并提供结果，以及采用由提供者发起的普遍方法来提供检测。在牙科环境中进行艾滋病检测的障碍和促进因素方面出现了六个相关主题：牙科机构的 POCT 使用率与其他非专业医疗机构相当。干预措施操作化的关键在于对其价值和与牙科患者群体相关性的看法、对干预措施的态度、实施干预措施的后勤障碍、HIV 检测对患者与执业医师关系造成污名化的风险以及在牙科环境的限制下最大限度地适应干预措施。

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来源期刊

Community dentistry and oral epidemiology 医学-公共卫生、环境卫生与职业卫生

CiteScore

4.40

自引率

8.70%

发文量

审稿时长

6 months

期刊介绍： The aim of Community Dentistry and Oral Epidemiology is to serve as a forum for scientifically based information in community dentistry, with the intention of continually expanding the knowledge base in the field. The scope is therefore broad, ranging from original studies in epidemiology, behavioral sciences related to dentistry, and health services research through to methodological reports in program planning, implementation and evaluation. Reports dealing with people of all age groups are welcome. The journal encourages manuscripts which present methodologically detailed scientific research findings from original data collection or analysis of existing databases. Preference is given to new findings. Confirmations of previous findings can be of value, but the journal seeks to avoid needless repetition. It also encourages thoughtful, provocative commentaries on subjects ranging from research methods to public policies. Purely descriptive reports are not encouraged, nor are behavioral science reports with only marginal application to dentistry. The journal is published bimonthly.