Adoption of Point of Care HIV Testing by General Dentistry Residents in Two New York City Dental Clinics

Objectives: Saliva-based point-of-care (POC) HIV testing in dental settings may help reach new populations unaware of their HIV status; however, evidence on what factors facilitate or impede dental providers’ willingness to deliver POC HIV testing is limited. A Best Practice Advisory was added to the Electronic Health Record (EHR) to enable selection of patients for POC testing. The EHR at the medical center is shared across all medical practices including dentistry. This enabled the opportunity for collaboration with Infectious Disease Specialists to educate dental residents on POC testing and information on pre-exposure prophylaxis for patients at risk for HIV.
Methods: In 2022-2023, general dentistry residents from two urban hospital based programs were trained to administer a saliva-based POC HIV antibody test (3^rd generation OraQuick) to adult patients with recent testing for sexually transmitted diseases and/or no history of HIV testing. A total of 20 residents across two sites completed an online survey to assess socio-demographics, HIV knowledge, comfort with HIV testing and counseling, and acceptability and feasibility of HIV testing in the dental setting. We applied Coincidence Analysis (CNA) to the survey responses to identify specific combinations of “difference making” factors that distinguished dental residents with high rates of HIV testing (≥10% of instances when patient was eligible for HIV testing) from residents with low HIV testing rates. CNA is a form of configurational analysis that can accommodate small sample sizes and uses Boolean logic to identify key difference makers of an outcome.
Results: Across the 27 potential factors evaluated, two conditions when jointly met, led to 100% sensitivity and specificity in distinguishing residents with had high (n=7) versus low HIV testing rates (n=13): (1) implementation readiness practicing at a dental clinic ready to implement HIV testing early in the pilot study (2) moderate to high resident comfort delivering HIV test results. Resident sociodemographic characteristics (e.g., age, race, ethnicity, gender, languages spoken), self-reported acceptability or feasibility of the intervention, and HIV knowledge were not difference makers.
Conclusions: Site-level and individual-level factors conjointly influence adoption of HIV testing by dental residents. Training and support to increase comfort with delivering positive HIV test results should be prioritized to increase adoption of HIV testing among residents in dental settings.