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Innovations in Oral Health Care Initiative

About this initiative...
Background
Grantees
Journal Articles
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Background

The SPNS Innovations in Oral Health Care Initiative funded 15 demonstration sites for five years to develop innovative models of care providing oral health care services to underserved HIV populations in both urban and non-urban settings. Despite the importance of access to quality oral health care, large numbers of people with HIV reportedly have unmet needs for oral health care. Inadequate oral health care can undermine success of HIV treatment regimens as well as diminish quality of life for those living with HIV. Therefore, the demonstration sites of this initiative provided comprehensive oral health care services to HIV-positive clients and developed individualized treatment plans for each patient receiving service. The demonstration sites also participated in a multi-site evaluation conducted by the Health and Disability Working Group at Boston University, which served as the Evaluation Center for this initiative.

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Grantees

HRSA awarded grants to the organizations listed below, with links to brief descriptions of their demonstration projects.

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Lutheran Medical Center

This four-part proposal sought to create partnerships between the Department of Health and community health centers in the U.S. Virgin Islands and Lutheran Medical Center, a Brooklyn, NY community and teaching hospital, to provide preventive, restorative, and prosthetic oral health services to underserved HIV+/AIDS patients.  Grant funding re-equipped four dental treatment rooms in Year 1 (plus two more in Year 2) and reestablished services at three sites in St. Croix and on in St. Thomas. A full-time dentist provided direct patient care and supervised  Lutheran Medical Center residents assigned to these clinics. The grantee also created a 40-hour distance learning curriculum for oral health providers trained to treat HIV+ persons, and implemented a research effort to evaluate the OraQuick HIV test during routine dental examinations.

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Louisiana State University

The HIV Outpatient Program of the Medical Center of Louisiana at New Orleans (MCLNO) was  well-experienced in the provision of oral health services to people living with HIV/AIDS.  Loss of healthcare facilities due to hurricane Katrina offered a unique opportunity to develop and implement new and innovative methods of delivering dental care, while building upon ten years of prior experience. This project utilized a mobile dental unit traveling between six community health center, in two distinct phases. During the first year, dental care was provided using a best practices model, and data regarding attitudes and beliefs about oral health, and client need for oral health care, was collected from HIV positive clients. The service delivery systems were then  modified to accommodate this consumer input.  

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Montefiore Medical Center

Montefiore Medical Center (MMC), an urban demonstration site for the Oral Health Initiative,  designed and implemented an integrative model of dental and medical primary care. This model involved integrating a dental hygienist into an existing HIV specialty team consisting of a treatment educator, nutritionist, pharmacist, and mental health social worker, and the delivery of  dental services utilizing a mobile dental unit.

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Special Health Resources for Texas (SHRT)

This project established a partnership between SHRT, the Texas A&M University Baylor College of Dentistry, and Meyers, Villa & Associates. SHRT served as the lead agent for the project, assuming responsibility for administrative and programmatic oversight. SHRT also provided oral health education to persons infected with HIV that included information on dental/oral health, service availability and referral. To monitor and track service delivery, SHRT employed a case manager to assist clients retain their oral health care services and also to collect appropriate data.

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St. Luke's-Roosevelt Hospital Center, Center for Comprehensive Care (CCC)

The Center for Comprehensive Care developed and evaluated an innovative and replicable model of care, "Keep Your Smile Sharp" (KYSS), to provide oral health care to HIV-positive, underserved populations. Project KYSS was delivered at community-based sites in three  neighborhoods of Manhattan in New York City with high prevalence rates of HIV and inadequate oral health resources. The program sought to offer the full range of oral health services currently provided by the CCC at its two HIV outpatient clinics, complemented by a program of community education conducted in collaboration with community organizations. The project’s target population was composed of HIV-positive persons who did not access oral health care, those who accessed care on an episodic basis, and may or may not have been receiving consistent HIV primary care. Project KYSS linked those without HIV outpatient care to ensure that program enrollees received coordinated HIV oral health and primary care.

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University of Miami School of Medicine

The Miami Dental Access Program (MDAP) sought to increase access to oral health care services for HIV-infected patients and to decrease identified barriers to care. MDAP developed,  implemented and evaluated an innovative mobile dental program for medically underserved persons living with HIV in the urban area of Miami-Dade County. The program emphasized  prevention, early intervention, and linkage to comprehensive oral health care for low income persons living with HIV. MDAP linked with an HIV primary care clinic that did not have on-site dental care in Miami-Dade County and provided same-day dental services to patients being seen for HIV primary care initial screenings.

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AIDS Care Group

The AIDS Care Group established a new satellite dental office and targeted HIV positive patients living in Chester, Lancaster, and York Counties of Pennsylvania. Access to dental care in these counties is limited by insurance status, poverty, disease stigma, and lack of transportation. In addressing these barriers, the AIDS Care Group implemented a Demonstration Model of Oral Health Care and collaborated with current HIV/AIDS medical and services providers to link their patients into the project. Start-up activities included equipping a new one-chair dental office in Coatesville, Chester County; hiring a dentist to work with the AIDS Care Group's dentists; training auxiliary staff; establishing transportation systems; and developing evaluation measures.

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AIDS Resource Center of Wisconsin (ARCW)

ARCW sought to extend dental services into a 51-county rural service area in greater Wisconsin, where HIV dental services were unavailable. ARCW's innovative hybrid model of providing care included the establishment of an HIV Dental Clinic in Green Bay, WI which had the highest concentration of HIV cases in the service area.  The project also developed an HIV Dental Reimbursement Program for parts of the service delivery area with lower concentrations of HIV cases.

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HIV Alliance of Lane County

The HIV Alliance of Lane County partnered with the Community Health Centers of Lane County and Lane Community College to provide reduced cost, comprehensive oral health care to HIV patients by conventional oral health care providers in the region. The Community Health Centers is an association of many groups including HIV Alliance.  Dental care for southern Oregon was provided in the Lane Community College dental clinic, which was readily accessible from Interstate 5 and by frequent Lane Transit District busses from both Eugene and Springfield. Lane Community College’s modern, 18 chair dental clinic in Eugene, Oregon had not been fully used by its dental program until the project began.

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Community Health Center, Inc.

The Community Health Center, Inc. sought to provide new oral health care services to the 400 low-income HIV+ residents of Norwalk, CT and an approximate 200 HIV+ residents from areas surrounding the city.  CDC provided 1 day of dentistry and 1 day of hygiene services at our new dental clinic in Norwalk which opened in December of 2006, and added another day of hygiene services at another existing site. Key features of the intervention included referral coordination services; a comprehensive continuum of oral health services (restorative, diagnostic, preventive, periodontal, prosthodontic, endodontic, oral medications, oral surgery, emergency care and oral health education/health promotion); 24-hour emergency care; and health education/ promotion onsite at our full-service clinic. CHC also employed a driver one day per week to bring patients who lack reliable transportation (the majority of our target population) directly to our clinic.

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University of North Carolina at Chapel Hill

This project established a collaborative group of investigators to conduct a multidisciplinary oral health program to address the dental needs of newly diagnosed HIV positive individuals from the Research Triangle/Piedmont regions of North Carolina. The project evaluated the oral health of newly diagnosed patients compared with that of HIV positive individuals who already received  their routine dental care at the UNC Hospitals dental clinic. Comparison between the two groups  assessed the impact of initiation of oral health care in the HIV population early rather than in the midst of medical treatment or emergency.

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Harbor Health Services, Inc.

Harbor Health Services, Inc. (HHSI) designed an HIV Oral Health Collaborative model to increase accessibility and affordability of dental services for people living with HIV/AIDS (PLWHA) on Cape Cod. HHSI created a new dental site in the Outer Cape in collaboration with Outer Cape Health Services and expanded existing services at its two community dental sites located in the Mid and Lower Cape. The dental clinics used a collaborative model of care where patients were referred by partner agencies to the dental clinics. Dental case managers coordinated dental services, followed up with referring agencies on visit outcomes, and ensured that patients were linked to primary care and social services. HHSI currently partners with Cape Cod Healthcare-Infectious Disease Clinical Services, a Part C grantee in the provision of dental and primary care services.

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The Native American Health Center, San Francisco

The Native American Health Center's HIV+ Oral health Program and Evaluation (HOPE) Project sought to establish NAHC as the “dental home” for HIV+ San Franciscans of color, with referrals  for specialty dental care. The "dental home" model stressed three core components: dental case management, dental services on-site (including prevention of oral disease and maintenance of oral health), and specialty dental services off-site in Partner Specialty Dentists' (PSD) offices. The HOPE Project's innovative interventions included dental case management and broadening the dental safety net via partnerships with private-practice specialists.

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Sandhills Medical Foundation, Inc.

Sandhills Medical Foundation (SMF) implemented Project Save Our Smiles (SOS) to provide oral health care to persons living with HIV/AIDS in a rural, six-county region of South Carolina. To respond to these needs, SMF purchased a mobile dental unit with two operatories, staffed by a specially-trained team including a dentist, dental hygienist, and dental assistant. The mobile dental unit visited three rural community health center sites on a scheduled basis, with staff at these sites scheduling their HIV patients with oral health care visits.

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Tenderloin Health

This project was a collaboration of the Tenderloin Health; San Francisco Department of Public Health’s Tom Waddell Health Center (TWHC) & Dental Services; Asian & Pacific Islander Wellness Center; and Positive Resource Center. These partners provided comprehensive oral health services incorporating many elements. HIV primary and oral health care services were co-located at  TARC and TWHC, where oral health care was integrated into an existing multidisciplinary program. While most dental services were provided at TARC and TWHC, a formal referral process and patient accompaniment ensured access to specialty services off-site. Case management and peer advocacy sought to increase access and patient adherence to treatment, and cultural competency & HIV care training were provided for oral health staff to ensure optimal working relationships with the target population. Training was also provided to non-oral health staff to ensure all team members understood the critical importance of good oral health in the context of HIV primary care. Outreach, patient education & early intervention activities ensured patient engagement, increased receptivity to care, and participation in their oral care.

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Journal Articles

Bachman SS, Abel SN, & Reznik DA.  New approaches to oral health care for people living with HIV/AIDS. Public Health Reports, May 2012; 127 (Supplement 2): 3-4. PubMed

Fox JE, Tobias CR, Bachman SS, Reznik DA, Rajabiun S, & Verdecias N.  Increasing access to oral health care for people living with HIV/AIDS in the U.S.: baseline evaluation results of the Innovations in Oral Health Care Initiative. Public Health Reports, May 2012; 127 (Supplement 2): 5-16. PubMed Abstract

Jeanty Y, Cardenas G, Fox JE, Pereyra M, Diaz C, Bednarsh H, Reznik DA, Abel SN, Bachman SS, & Metsch LR. Correlates of Unmet Dental Care Need Among HIV Positive People Since Being Diagnosed with HIV.  Public Health Reports, May 2012; 127 (Supplement 2): 17-24. PubMed Abstract

Walter AW, Bachman SS, Reznik DA, Cabral H, Umez-Eronini A, Nath A, Flournoy MW, Young NS. Methamphetamine use and dental problems among adults enrolled in a program to increase access to oral health services for people living with HIV/AIDS. Public Health Reports, May 2012; 127 (Supplement 2): 25-35. PubMed Abstract

Singer R, Cardenas G, Xavier J, Jeanty Y, Pereyra M, Rodriguez A & Metsch LR. Assessment of Dental Anxiety and the Use of Oral Health Services Among People Attending Two HIV Primary Care Clinics. Public Health Reports, May 2012; 127 (Supplement 2): 36-44. PubMed Abstract

Tobias CR, Fox JE, Walter AW, Lemay CA, & Abel SN. Retention of people living with HIV/AIDS in oral health care. Public Health Reports, May 2012; 127 (Supplement 2): 45-54. PubMed Abstract

Bachman SS, Walter AW, & Umez-Eronini A. Access to oral health care and self-reported health status among low-income adults living with HIV/AIDS. Public Health Reports, May 2012; 127 (Supplement 2): 55-64. PubMed Abstract

Jones J, Mofidi M, Bednarsh H, Gambrell A, & Tobias CR. Increasing access to oral health care for people living with HIV/AIDS in rural Oregon. Public Health Reports, May 2012; 127 (Supplement 2): 65-72. PubMed Abstract

Rajabiun S, Fox JE, McCluskey A, Guevara E, Verdecias N, Jeanty Y, DeMayo M, & Mofidi M. Patient perspectives on improving oral health-care practices among people living with HIV/AIDS.  Public Health Reports, May 2012; 127 (Supplement 2): 73-81. PubMed Abstract

Bednarsh H, Reznik DA, & Tobias CR. Financing oral health care for low-income adults living with HIV/AIDS. .Public Health Reports, May 2012; 127 (Supplement 2): 82-86. PubMed Abstract

Rajabiun S, Bachman SS, Fox JE, Tobias C, & Bednarsh H. A typology of models for expanding access to oral health care for people living with HIV/AIDS.  Journal of Public Health Dentistry, Summer 2011; 71(3): 212-219.  PubMed Abstract

Part F - SPNS Resources

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Part F - SPNS Products and Publications

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SPNS Staff

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Pamela Belton
Public Health Analyst
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Renetta Boyd
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