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Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23. Published in final edited form as: Afr J Med Med Sci. 2014 September ; 43(Suppl 1): 201–208.
HIV TESTING IN DENTAL PRACTICE: PERCEPTION AND ATTITUDE OF DENTISTS IN SOUTHWESTERN NIGERIA E.O. Abe1, B. Kolude1, and B.F. Adeyemi1 1Department
of Oral Pathology/ Oral Medicine, Faculty of Dentistry, College of Medicine, University of Ibadan/ University College Hospital, Ibadan, Oyo State
Author Manuscript
SUMMARY Background—In recent times, the concept of routine HIV screening has been recommended to enhance early diagnosis and timely initiation of care thereby reducing morbidity and mortality among HIV infected persons. Dental practice has been identified as a unique venue of reaching atrisk individuals who may not otherwise access the conventional healthcare settings. Aim—To assess the perception and attitude of dentists in Southwestern Nigeria concerning integrating HIV testing into dental practice. Methods—this descriptive cross- sectional study was conducted between January–March, 2014. Convenience sampling was used to select 113 practising dentists within Southwest Nigeria. Data collection was done using a self- administered questionnaire.
Author Manuscript
Results—Agreement to HIV testing in dental settings was in the order of 100% for private practitioners followed by 91.7% from teaching hospitals (91.7%) and least agreement was with state hospitals (76.5%). There was a strong association between participants’ years of practice and support for HIV testing in dental settings with highest support among those between 7–9 years (p= 0.002). Significantly too (p= 0.013), all the specialists (100%) agreed to HIV testing in dental settings compared to general practitioners (84.0%). Conclusion—This study showed that most dentists in Southwest Nigeria acknowledged dental practice as being appropriate for expanded HIV testing and as well were willing to undergo training for HIV testing in their dental settings. Keywords
Author Manuscript
HIV testing; dental practice; saliva; attitude; Nigeria
Introduction HIV/AIDS pandemic is one of the most important public health problems with profound effect on the lives of infected people and their families [1]. According to the 2008 National HIV sero-prevalence documentation, Nigeria has HIV prevalence of 4.6%. All the 36 states, and Federal Capital have above 1% with 17 states having greater than 5% sero-prevalence
Correspondence: Dr. Abe E.O., Department of Oral Pathology/ Oral Medicine, University College Hospital, Ibadan, Oyo State, Nigeria. [email protected].
Abe et al.
Page 2
Author Manuscript
rate [2]. The number of new infection is about 323,000 adults and 57,000 children [2]. Nigeria has the second highest number of HIV positive adults in sub- Saharan Africa due to the large population size though the sero-prevalence rate is lower than some African countries like Kenya -15%, South Africa -20%, Zambia -21.5% and Zimbabwe -34% [3].
Author Manuscript
In 2006, the Centers for Disease Control and Prevention’s (CDC) revised HIV testing guidelines recommended that HIV testing be considered as part of routine care in all health care settings in the United States [4,5]. The implementation of routine HIV screening among Americans was proposed to enhance early diagnosis, timely initiation of care and facilitation of rapid access to antiretroviral therapy which helps in viral load reduction, reduced infectivity and morbidity as well as mortality among HIV infected persons [10,11]. Pollack et al analysed U.S. based National Health Interview Survey data and found that 3.6 million persons at significant risk for HIV had never been tested, among which 75% had been to a dentist within past the two years. The authors deduced that HIV testing in the dental setting has a great potential for reaching high risk individuals [7]. Considering the need for expansion of health care settings that will facilitate early diagnosis of HIV, the dental setting has been recognized as a venue for identifying at- risk individuals who may not otherwise access medical and public health systems [6]. Given that some atrisk individuals may be missed by risk-based HIV testing alone, routine HIV testing in conventional and nontraditional health-care settings, such as dental clinics, has been promoted as an approach to increase opportunities for early HIV detection which gives a better prognosis, reduced risk of HIV transmission and is cost effective [11–16].
Author Manuscript
Various models for rapid HIV testing in the dental setting have been suggested, including counseling and testing performed by the oral health provider, by a member of the dental staff such as a dental assistant, or by a trained counselor [13]. This rapid testing will depend on the dental practice type (private practice or hospital- based), financial resources and staff support [6]
Author Manuscript
Notably, dentistry is moving towards continued integration with other healthcare specialties through incorporation of advanced and innovative diagnostic testing into dental practice such as saliva-based diagnostic testing [8]. This rapid oral-testing technology permits a highly sensitive and specific, fast, simple, minimally invasive, cost-effective way to screen for HIV sero-status in which dental offices provide a promising venue for such testing [8,9]. The advent of rapid HIV screening technology (oral- fluid based) allows individuals to learn their HIV status in approximately twenty minutes, well within the time frame of a routine dental visit [12] which is usually followed by other tests like ELISA and Western blot in positive cases. The advantages of rapid HIV tests, particularly with oral fluid specimen, include increased acceptability of testing among populations at risk for HIV infection and increased receipt of test results [14]. It also eliminates the risk for needle stick injury and transmission of HIV virus from oral fluid is unlikely [10]. Essentially, access to HIV primary care to ensure linkage to care and treatment should also be considered in the integration of HIV testing into dental care [6].
Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
Abe et al.
Page 3
Author Manuscript
Despite these recent advances of expanded HIV testing in dental settings in developed countries and its relevance in early detection of sero- positive patients, there is dearth of literature on the feasibility and acceptability of HIV test in dental settings in Nigeria. This study is therefore aimed at assessment of the perception and attitude, as well as perceived barriers to integrating HIV testing into dental practice by dentists in South Western Nigeria.
Materials and Method This descriptive cross- sectional survey was conducted in Southwestern Nigeria between January–March, 2014. Three states (Lagos, Osun and Oyo) were selected out of the six states in the Southwestern region of Nigeria by simple randomization.
Author Manuscript
A convenience sampling of study participants was used, recruiting dentists attending organized Continuing Medical Education program at the state-level and also at departmental seminars of various hospital settings. Health facilities with VCT services were purposively selected. Ethical approval was sought and obtained from University of Ibadan/ University College Hospital Joint Ethical Review Committee. Data collection was done using a self- administered questionnaire after careful explanation of the aim and expected outcome of the study to participants. Verbal consent was taken and return of duly filled questionnaire was taken as a measure of consent. Exclusion criteria were declined consent and non response or inadequate response by participants.
Author Manuscript
Data was collected on various factors including socio- demographic characteristics and knowledge about respondents’ HIV status. The attitude of the respondents towards HIV testing in dental setting plans for its implementation and perceived reasons for lack of plans for such implementation were investigated. Other questionnaire items included their view of ideal dental setting for HIV testing, knowledge about rapid HIV testing and their willingness to undergo training for HIV testing in dental clinics. Data was analysed using software package of SPSS version 15.0. Descriptive statistics of mean, standard deviation and/or percentages were used to summarize the socio-demographic data (sex, age, marital status, professional status, type of practice and years of practice). Pearson’s chi- square test was used to determine strength of association between categorical variables. The level of significance for this study was set at level of p 40
6(9.7)
2(5.9)
Single
42(61.8)
21(44.7)
Married
26(32.8)
26(55.3)
χ2-value
p-value
0.767
0.682
3.244
0.053
Age (years)
Marital status
Author Manuscript Author Manuscript Author Manuscript Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
Abe et al.
Page 11
Table 2
Author Manuscript
Relationship between HIV testing and gender
Do you know your HIV status?
Do you support HIV testing in a dental setting?
Are you willingness to undergo training for rapid HIV testing in a dental clinic?
Male (%)
Female (%)
p-value
YES
55 (87.3)
46 (100.0)
0.012*
NO
8 (12.7)
0 (0)
YES
51 (83.6)
46 (97.9)
NO
10 (16.4)
1 (2.1)
YES
44 (88.0)
33 (89.2)
NO
6 (12.0)
4 (10.8)
*
= significant
Author Manuscript Author Manuscript Author Manuscript Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
0.015*
0.863
Author Manuscript
Author Manuscript
Author Manuscript
= significant
*
Years of practice:
Type of practice:
Area of practice:
NO (0) 4 (23.5) 7 (8.3) 8 (16.0) 0 (0) 4 (7.4) 1 (5.3) 0 (0) 6 (35.3)
YES 6 (100.0) 13 (76.5) 77 (91.7) 42 (84.0) 35 (100.0) 50 (92.6) 18 (94.7) 18 (100.0) 11 (64.7)
Private State hospital Teaching hospital General Specialists 0–3 years 4–6 years 7–9 years >10 years
Do you support HIV testing in dental setting
14.716
6.182
4.268
χ2-value
0.002*
0.013*
0.118
P-value
Relationship between professional characteristics and respondents’ perception on HIV testing in dental settings.
Author Manuscript
Table 3 Abe et al. Page 12
Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
Abe et al.
Page 13
Table 4
Author Manuscript
Participants’ responses to HIV testing in dental settings Assessed issues on HIV testing in dental practice
Frequency (n)
Percentage (%)
a. General hospital outpatient
18
13.2
b. Dental school outpatient
13
9.6
c. Dental room emergency
9
6.6
d. Community dental clinic
10
7.4
e. All are equally important
13
9.6
73
53.7
a. Useful in settings of limited infrastructures
65
31.6
b. Cheaper than conventional test
43
20.9
c. Requires further evaluation at reference laboratory
45
21.8
d. Combination of multiple rather than single rapid test is advisable
29
14.1
e. Always non invasive
8
3.9
YES
16
14.2
NO
83
73.5
No response
14
12.4
a. Poor understanding of rationale
19
14.0
b. Revenue constraint
22
16.2
c. Lack of willingness and interest
21
15.4
d. Lack of societal motivation on HIV testing in dental clinic
16
11.8
e. Lack of insurance coverage
12
8.8
f. No urgent need for HIV testing in dental clinic
9
6.6
g. Policy and plan should come from management
37
27.2
Participants’ choice of ideal dental setting for HIV test
Participants’ knowledge on rapid HIV test
Author Manuscript
Do you have documented plans for HIV testing In your dental setting?
Perceived reasons for lack of plans for HIV testing in dental setting
Author Manuscript Author Manuscript
Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23. Published in final edited form as: Afr J Med Med Sci. 2014 September ; 43(Suppl 1): 201–208.
HIV TESTING IN DENTAL PRACTICE: PERCEPTION AND ATTITUDE OF DENTISTS IN SOUTHWESTERN NIGERIA E.O. Abe1, B. Kolude1, and B.F. Adeyemi1 1Department
of Oral Pathology/ Oral Medicine, Faculty of Dentistry, College of Medicine, University of Ibadan/ University College Hospital, Ibadan, Oyo State
Author Manuscript
SUMMARY Background—In recent times, the concept of routine HIV screening has been recommended to enhance early diagnosis and timely initiation of care thereby reducing morbidity and mortality among HIV infected persons. Dental practice has been identified as a unique venue of reaching atrisk individuals who may not otherwise access the conventional healthcare settings. Aim—To assess the perception and attitude of dentists in Southwestern Nigeria concerning integrating HIV testing into dental practice. Methods—this descriptive cross- sectional study was conducted between January–March, 2014. Convenience sampling was used to select 113 practising dentists within Southwest Nigeria. Data collection was done using a self- administered questionnaire.
Author Manuscript
Results—Agreement to HIV testing in dental settings was in the order of 100% for private practitioners followed by 91.7% from teaching hospitals (91.7%) and least agreement was with state hospitals (76.5%). There was a strong association between participants’ years of practice and support for HIV testing in dental settings with highest support among those between 7–9 years (p= 0.002). Significantly too (p= 0.013), all the specialists (100%) agreed to HIV testing in dental settings compared to general practitioners (84.0%). Conclusion—This study showed that most dentists in Southwest Nigeria acknowledged dental practice as being appropriate for expanded HIV testing and as well were willing to undergo training for HIV testing in their dental settings. Keywords
Author Manuscript
HIV testing; dental practice; saliva; attitude; Nigeria
Introduction HIV/AIDS pandemic is one of the most important public health problems with profound effect on the lives of infected people and their families [1]. According to the 2008 National HIV sero-prevalence documentation, Nigeria has HIV prevalence of 4.6%. All the 36 states, and Federal Capital have above 1% with 17 states having greater than 5% sero-prevalence
Correspondence: Dr. Abe E.O., Department of Oral Pathology/ Oral Medicine, University College Hospital, Ibadan, Oyo State, Nigeria. [email protected].
Abe et al.
Page 2
Author Manuscript
rate [2]. The number of new infection is about 323,000 adults and 57,000 children [2]. Nigeria has the second highest number of HIV positive adults in sub- Saharan Africa due to the large population size though the sero-prevalence rate is lower than some African countries like Kenya -15%, South Africa -20%, Zambia -21.5% and Zimbabwe -34% [3].
Author Manuscript
In 2006, the Centers for Disease Control and Prevention’s (CDC) revised HIV testing guidelines recommended that HIV testing be considered as part of routine care in all health care settings in the United States [4,5]. The implementation of routine HIV screening among Americans was proposed to enhance early diagnosis, timely initiation of care and facilitation of rapid access to antiretroviral therapy which helps in viral load reduction, reduced infectivity and morbidity as well as mortality among HIV infected persons [10,11]. Pollack et al analysed U.S. based National Health Interview Survey data and found that 3.6 million persons at significant risk for HIV had never been tested, among which 75% had been to a dentist within past the two years. The authors deduced that HIV testing in the dental setting has a great potential for reaching high risk individuals [7]. Considering the need for expansion of health care settings that will facilitate early diagnosis of HIV, the dental setting has been recognized as a venue for identifying at- risk individuals who may not otherwise access medical and public health systems [6]. Given that some atrisk individuals may be missed by risk-based HIV testing alone, routine HIV testing in conventional and nontraditional health-care settings, such as dental clinics, has been promoted as an approach to increase opportunities for early HIV detection which gives a better prognosis, reduced risk of HIV transmission and is cost effective [11–16].
Author Manuscript
Various models for rapid HIV testing in the dental setting have been suggested, including counseling and testing performed by the oral health provider, by a member of the dental staff such as a dental assistant, or by a trained counselor [13]. This rapid testing will depend on the dental practice type (private practice or hospital- based), financial resources and staff support [6]
Author Manuscript
Notably, dentistry is moving towards continued integration with other healthcare specialties through incorporation of advanced and innovative diagnostic testing into dental practice such as saliva-based diagnostic testing [8]. This rapid oral-testing technology permits a highly sensitive and specific, fast, simple, minimally invasive, cost-effective way to screen for HIV sero-status in which dental offices provide a promising venue for such testing [8,9]. The advent of rapid HIV screening technology (oral- fluid based) allows individuals to learn their HIV status in approximately twenty minutes, well within the time frame of a routine dental visit [12] which is usually followed by other tests like ELISA and Western blot in positive cases. The advantages of rapid HIV tests, particularly with oral fluid specimen, include increased acceptability of testing among populations at risk for HIV infection and increased receipt of test results [14]. It also eliminates the risk for needle stick injury and transmission of HIV virus from oral fluid is unlikely [10]. Essentially, access to HIV primary care to ensure linkage to care and treatment should also be considered in the integration of HIV testing into dental care [6].
Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
Abe et al.
Page 3
Author Manuscript
Despite these recent advances of expanded HIV testing in dental settings in developed countries and its relevance in early detection of sero- positive patients, there is dearth of literature on the feasibility and acceptability of HIV test in dental settings in Nigeria. This study is therefore aimed at assessment of the perception and attitude, as well as perceived barriers to integrating HIV testing into dental practice by dentists in South Western Nigeria.
Materials and Method This descriptive cross- sectional survey was conducted in Southwestern Nigeria between January–March, 2014. Three states (Lagos, Osun and Oyo) were selected out of the six states in the Southwestern region of Nigeria by simple randomization.
Author Manuscript
A convenience sampling of study participants was used, recruiting dentists attending organized Continuing Medical Education program at the state-level and also at departmental seminars of various hospital settings. Health facilities with VCT services were purposively selected. Ethical approval was sought and obtained from University of Ibadan/ University College Hospital Joint Ethical Review Committee. Data collection was done using a self- administered questionnaire after careful explanation of the aim and expected outcome of the study to participants. Verbal consent was taken and return of duly filled questionnaire was taken as a measure of consent. Exclusion criteria were declined consent and non response or inadequate response by participants.
Author Manuscript
Data was collected on various factors including socio- demographic characteristics and knowledge about respondents’ HIV status. The attitude of the respondents towards HIV testing in dental setting plans for its implementation and perceived reasons for lack of plans for such implementation were investigated. Other questionnaire items included their view of ideal dental setting for HIV testing, knowledge about rapid HIV testing and their willingness to undergo training for HIV testing in dental clinics. Data was analysed using software package of SPSS version 15.0. Descriptive statistics of mean, standard deviation and/or percentages were used to summarize the socio-demographic data (sex, age, marital status, professional status, type of practice and years of practice). Pearson’s chi- square test was used to determine strength of association between categorical variables. The level of significance for this study was set at level of p 40
6(9.7)
2(5.9)
Single
42(61.8)
21(44.7)
Married
26(32.8)
26(55.3)
χ2-value
p-value
0.767
0.682
3.244
0.053
Age (years)
Marital status
Author Manuscript Author Manuscript Author Manuscript Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
Abe et al.
Page 11
Table 2
Author Manuscript
Relationship between HIV testing and gender
Do you know your HIV status?
Do you support HIV testing in a dental setting?
Are you willingness to undergo training for rapid HIV testing in a dental clinic?
Male (%)
Female (%)
p-value
YES
55 (87.3)
46 (100.0)
0.012*
NO
8 (12.7)
0 (0)
YES
51 (83.6)
46 (97.9)
NO
10 (16.4)
1 (2.1)
YES
44 (88.0)
33 (89.2)
NO
6 (12.0)
4 (10.8)
*
= significant
Author Manuscript Author Manuscript Author Manuscript Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
0.015*
0.863
Author Manuscript
Author Manuscript
Author Manuscript
= significant
*
Years of practice:
Type of practice:
Area of practice:
NO (0) 4 (23.5) 7 (8.3) 8 (16.0) 0 (0) 4 (7.4) 1 (5.3) 0 (0) 6 (35.3)
YES 6 (100.0) 13 (76.5) 77 (91.7) 42 (84.0) 35 (100.0) 50 (92.6) 18 (94.7) 18 (100.0) 11 (64.7)
Private State hospital Teaching hospital General Specialists 0–3 years 4–6 years 7–9 years >10 years
Do you support HIV testing in dental setting
14.716
6.182
4.268
χ2-value
0.002*
0.013*
0.118
P-value
Relationship between professional characteristics and respondents’ perception on HIV testing in dental settings.
Author Manuscript
Table 3 Abe et al. Page 12
Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
Abe et al.
Page 13
Table 4
Author Manuscript
Participants’ responses to HIV testing in dental settings Assessed issues on HIV testing in dental practice
Frequency (n)
Percentage (%)
a. General hospital outpatient
18
13.2
b. Dental school outpatient
13
9.6
c. Dental room emergency
9
6.6
d. Community dental clinic
10
7.4
e. All are equally important
13
9.6
73
53.7
a. Useful in settings of limited infrastructures
65
31.6
b. Cheaper than conventional test
43
20.9
c. Requires further evaluation at reference laboratory
45
21.8
d. Combination of multiple rather than single rapid test is advisable
29
14.1
e. Always non invasive
8
3.9
YES
16
14.2
NO
83
73.5
No response
14
12.4
a. Poor understanding of rationale
19
14.0
b. Revenue constraint
22
16.2
c. Lack of willingness and interest
21
15.4
d. Lack of societal motivation on HIV testing in dental clinic
16
11.8
e. Lack of insurance coverage
12
8.8
f. No urgent need for HIV testing in dental clinic
9
6.6
g. Policy and plan should come from management
37
27.2
Participants’ choice of ideal dental setting for HIV test
Participants’ knowledge on rapid HIV test
Author Manuscript
Do you have documented plans for HIV testing In your dental setting?
Perceived reasons for lack of plans for HIV testing in dental setting
Author Manuscript Author Manuscript
Afr J Med Med Sci. Author manuscript; available in PMC 2015 December 23.
