Supporting HIV care through education and innovation

Oral Health Training Manual: Background of the SPNS Oral Health Initiative

Oral Health Training Manual: Background of the SPNS Oral Health Initiative

December 2013
Author:
IHIP
IHIP HRSA HIV/AIDS Bureau

Dentists show of the results of their work to a patientThe overall goal of the Oral Health Initiative was to expand access to comprehensive oral health care provided in accordance with professional standards to improve oral health outcomes of PLWHA. Oral health outcomes were defined as:

  • Patient experience with care,
  • Health of teeth and gums,
  • Completion of a Phase 1 treatment plan (the elimination of active disease and restoration of function), and
  • Retention in care.

Other important objectives of the SPNS Oral Health Initiative included integrating medical and dental care and sustaining programs beyond the life of the grant.

In order to achieve these objectives, many grantees employed dental case management with great success. In one study of a segment of SPNS Oral Health Initiative patients, the patients emphasized the importance of dental case managers as contributing to their reasons for returning to care.12 These dental case managers coordinating their care, made it easier for them to follow up on appointments, and also reduce their anxiety about dental care, making it more likely that they would be retained in care. (Dental case management is discussed in greater detail here).

Overall, the SPNS Oral Health Initiative has demonstrated excellent patient oral health and medical care outcomes, including:

  • Serving 2,500 PLWHA who had been out of oral health care for 1 year or more,
  • Enabling 14,500 patient visits, and
  • Performing 26,000 dental procedures.

But these numbers mean little unless considered in the context of the thousands of patients living happier and healthier lives as a result of the Initiative. “It’s definitely helped me,” remarks a patient at Harbor Health, a grantee in Provincetown, MA, about the care he’s received. “When [my dentists] did my top teeth, I had an infection in there for about probably one-and-a-half years. So my T-cells after all this jumped nearly 100 points,” he adds. “I feel a lot better.”

Organizational Models Studied

Each SPNS Oral Health Initiative demonstration site had to determine which organizational model(s) it would use, how it would recruit and train clinical staff, and how it would recruit patients into and retain in care. Six organizational models were used across the grantee sites (many utilized various combinations):

  1. Increasing services at existing clinics,
  2. Building satellite clinics,
  3. Collaborating with clinics in dental hygiene schools or community colleges,
  4. Fee-for-service dental reimbursement with contracted providers,
  5. Leasing space at existing private offices/clinics, and
  6. Purchasing mobile dental units.

Lessons learned around establishing various organizational models are addressed in greater detail in the following sections.

Oral Health and National HIV/AIDS Strategy

HRSA works diligently to meet the goals of the National HIV/AIDS Strategy (NHAS), designed to improve the course of the HIV epidemic in the United States. Needs assessments conducted by States and eligible metropolitan areas (EMAs) often identify oral health care as one of the greatest unmet needs among PLWHA. “The second and third goals of the NHAS have to do with increasing access, having desirable health outcomes, and reducing health disparities,” explains HRSA Chief Dental Officer Dr. Mayar Mofidi. “We know that oral health care is one of the top health care needs of patients with HIV,” he adds, “so working toward expanding access to dental care and reducing oral health disparities we can make a dent in achieving the National HIV/AIDS Strategy.”

The SPNS Oral Health Initiative has sought out and engaged dental providers and offered valuable training in the treatment of PLWHA and HIV stigma reduction education for dental students via those grantees that embarked on partnerships with dental teaching institutions. An implementation strategy of the NHAS involves linking patients to coordinated, continuous care—something achieved in this Initiative through dental case management services.

Overview of the Six SPNS Organizational Models Studied

Grantee Name & LocationGrantee TypeProgram ModelTarget Population Served
AIDS Care Group
Chester, PA
ASO
  • New satellite dental clinic in West Chester County, PA

PLWHA from communities of color in rural Pennsylvania

AIDS Resource Center of
Wisconsin
Green Bay, WI
ASO
  • New satellite dental clinic in Green Bay, WI
Uninsured and underinsured PLWHA in Green Bay and rural WI
Community Health Center of
Connecticut
Middletown, CT
CHC
  • New dental clinic in Norwalk, CT
PLWHA in Norwalk, CT, and surrounding areas
Harbor Health
Provincetown, MA
CHC
  • Expanding dental services at existing site and creating a new clinic
PLWHA in the mid- and outer- Cape Cod areas
HIV Alliance
Eugene, OR
ASO/Dental
hygiene school
collaboration
  • Collaboration with rural dental satellite clinics
PLWHA in 15 counties in southern Oregon
Louisiana State University
New Orleans, LA
University
  • Mobile dental unit
Underserved, at-risk, and PLWHA of color in New Orleans, LA
Lutheran Medical Center
New York City, NY
University
  • Training program
  • Satellite clinic in the U.S. Virgin Islands (USVI)
PLWHA in the USVI
Montefiore Medical Center
(MMC)
Bronx, NY
University
  • University-based dental program
  • Mobile dental unit
PLWHA receiving medical care at MMC community health centers
Native American Health
Center
San Francisco, CA
FQHC
  • Medical and dental program expanding existing dental services
PLWHA of color in San Francisco
Sandhills Medical Foundation
Jefferson, SC
CHC
  • Mobile dental unit
PLWHA in rural South Carolina
Special Health Resources
for Texas
Longview, TX
ASO
  • Satellite clinics
PLWHA in rural East Texas
St. Luke’s Roosevelt Hospital
New York City, NY
Hospital
  • Hospital-based HIV dental center expanding existing services
PLWHA in New York City not enrolled in hospital’s medical program
Tenderloin Health Center
San Francisco, CA
CBO
  • Collaboration with SF Dept of Health to create a new dental clinic at the Tenderloin Health Center
Homeless PLWHA with substance use and mental health disorders in the Tenderloin District
University of Miami
Miami, FL
University
  • University-based program using a mobile dental unit
PLWHA in the Miami area
University of North Carolina
Chapel Hill, NC
University
  • University hospital-based dental clinic expanding existing services
PLWHA patients in several counties of North Carolina
Boston University
(Evaluation and Technical
Assistance Center)
University
  • Evaluation and Technical Assistance Center
SPNS Oral Health Initiative grantees
ASO = AIDS Service Organization, CBO = Community-Based Organization, CHC = Community Health Center, FQHC = Federally Qualified Health Center

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