DOI: 10.1097/01.NPR.0000410281.60115.15
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PMID: 22334100
Issn Print: 0361-1817
Publication Date: 2012/03/13
HIV testing in dental care: Opportunities for nurse practitioner and dentist collaboration
Mary Katherine Hutchinson; Madeleine Lloyd
+ Author Information
Author Information: is an associate professor at New York University College of Nursing in New York, NY. This article was funded by a grant from the NIH.
Excerpt
In 2006, the CDC recommended that healthcare providers offer routine HIV screening to all adolescent and adult patients, ages 13 to 64, and that testing be incorporated into routine primary care.1,2 The CDC went on to recommend that testing be expanded into new venues.2 Unfortunately, many healthcare providers have been slow to implement these recommendations.1 In 2010, the American Academy of Nursing Expert Panel on Emerging and Infectious Diseases (AAN Expert Panel) endorsed widespread HIV testing and advocated for interdisciplinary partnerships between nurses and other healthcare providers in order to facilitate the implementation of the CDC recommendations.3 An excellent opportunity for this type of interdisciplinary partnership now exists between nurse practitioners (NPs) and dentists. Although dentists were not specifically addressed in the recommendations, dental practice sites represent unique and largely untapped opportunities to implement widespread HIV screening. Given that many Americans who have not seen a primary care provider in the last year have seen a dentist,4,5 screening at the dental site may reach many people who lack other sources of care. The recent development of rapid HIV diagnostic kits that test oral fluid (OraQuick Advance Rapid HIV 1/2 antibody test and Clearview HIV 1/2 Stat Pak)1,6 has made testing in dental care settings practical, as oral fluid testing is associated with and well-suited to dental practice. These testing kits are noninvasive, easy to use, and provide results in 15 to 20 minutes.1,6,7 Many primary care NPs are already familiar with their use, and sensitivity and specificity are reported to be excellent (OraQuick Advance sensitivity greater than 99% and specificity greater than 99.6%). Nonetheless, results are considered preliminary, and confirmatory testing with conventional HIV testing methods (Western blot) is required for those who screen positive.6–9
Like many other healthcare providers, dentists have been hesitant to incorporate HIV testing into their practices, despite pressure from leaders in the field.8,10–13 Recent studies have identified perceived barriers to HIV testing among dentists and dental students, including lack of knowledge of HIV testing, legal liability, and documentation procedures; discomfort in communicating with patients about HIV; time constraints and billing issues; and referring patients for follow-up care.14–16 In addition, some dentists have expressed concerns that patients might react negatively to being offered HIV screening in dental practice sites. However, a recent pilot study of dental patient and provider attitudes toward HIV screening in a large university dental clinic in New York City found that the vast majority of patients reacted positively toward the idea.
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