Project Summary
Identifying Factors to Improve Dental and Mental Health Care among People with HIV
Impaired oral health and psychiatric disorders, including substance use, disproportionally
impact people with HIV and AIDS (PWH). Conditions such as dental caries, salivary gland
disease, ulcers, periodontitis, leukoplakia, and candidiasis are associated with HIV and can
negatively impact quality of life. Depression, anxiety, substance use and other psychiatric
disorders in PWH are also associated with more dental problems and unmet oral health needs.
In addition, patient, provider, and system barriers interfere with the receipt of oral health care for
PWH. HIV care, behavioral health care, and dental care are largely siloed, making it difficult for
different health care clinics and different professionals to work together to provide coordinated
care. There is great need to investigate further how individual and system-level barriers,
behavioral health, and oral health intersect for PWH. In response to RFA-DE-23-002, this
proposed project will conduct biannual assessments over two years of 400 PWH, from the
Providence/Boston Center for AIDS Research HIV clinics, to identify modifiable individual and
system-level barriers and facilitators for engagement and adherence in oral, HIV, and behavioral
health care. Associations of longitudinal changes in oral, behavioral, and HIV symptoms and
their relationships with barriers and facilitators will also be examined. In addition, in-depth
interviews with 40 PWH from the longitudinal study, and 20 health care workers (from dental,
behavioral, and HIV clinical settings) will provide further details on the nature of the barriers and
facilitators to care, and suggest opportunities for improvement. Using this combined quantitative
and qualitative data, strategies will be selected for clinic-based programs to improve oral and
behavioral health care among PWH. Member checking, also known as participant validation, will
examine the feasibility and acceptability of the selected strategies and actions through focus
groups with 20 PWH from the longitudinal study and 10 health care workers from dental,
behavioral, and HIV clinical settings. This will be one the largest, in-depth, prospective
assessments to date of oral health among PWH that assesses behavioral health and other
factors that directly influence oral health outcomes. These results will directly inform a research
agenda beyond this study to improve oral and behavioral health among PWH.