ABSTRACT
Oral diseases (periodontal disease, caries, and xerostomia) have major deleterious effects on long-term health
and quality of life, and are thought to be more prevalent in older adults living with HIV. Despite this, oral and
dental health remains a neglected area of research within the field of HIV and associated clinical care, and is
absent from nearly all HIV clinical guidelines in Sub-Saharan Africa. A demonstrated reciprocal association
between geriatric syndromes and poor oral health that affects quality of life among older people living with HIV
has been well described in the developed world such as the US but not in resource limited settings such as
Uganda. We hypothesize that the combined effects of HIV, frailty, depression, and cognitive decline are risk
factors for poorer oral health and quality of life among older people living with HIV. Our goal is to determine the
impacts of the geriatric syndromes (frailty, depression, and cognitive decline) on oral health and quality of life in
people with HIV, and to explore the mechanisms of integration of oral health services into routine HIV care in
the context of rural Sub-Saharan Africa. The specific aims for this study are: 1a) to determine the contributions
of frailty, neurocognition, and depression as risks to the epidemiology of periodontal disease, dental caries,
and xerostomia among older adults living with and without HIV in Uganda, 1b) to estimate the contributions of
periodontal disease, dental caries and xerostomia to oral and overall health-related quality of life, and 2) to
explore the barriers to and facilitators of integration of oral health services into routine HIV care in Uganda. To
achieve this goal we will leverage the existing clinical research infrastructure/NIH-supported longitudinal cohort
(UGANDAC, R01 AG059504, PI Mark Siedner) study of older adults aged 50 and older living with HIV in
southwestern Uganda and their age and gender-matched HIV uninfected controls. Our proposed research is
unique in that it will be: a) among the first to describe the epidemiology of oral health, the contributions of HIV,
and geriatric syndromes on oral health in Uganda, b) focuses on quality of life and well-being among older
people in a vulnerable, diverse population, and c) uses mixed methods research to both describe the
determinants of poor health and develop interventions to respond to a public health need to improve oral health
in a high-risk population. We have a multidisciplinary team of professional physicians and scientists from Africa
and the US that brings broad expertise in oral, mental, and HIV care and research; epidemiology, biochemistry,
and global population public health to achieve the set independent proposed aims of this application. The
study's findings will show the most frequent oral and dental health problems among Ugandan older individuals
living with HIV, their effects on quality of life, and, most importantly, their determinants. As a result, we will be
in a better position to design an intervention in southwestern Uganda to assess the inclusion of an oral and
dental health preventive and promotion program to routine HIV care. The findings will form the basis for our
applications for an R01 funded clinical trial to design and study this intervention.
