HIV saliva testing in the dental clinic setting: Challenges and facilitators to implementation

Expansion of HIV testing among populations at greatest risk for HIV has been recommended by the CDC through implementation of routine testing into health care settings and expanding testing in new venues. NYU College of Dentistry (NYUCD), the single largest “safety net” provider of dental care in New York State, provides comprehensive oral care to 124,000 patients (300,000 visits) each year. In recent years, with the development of saliva testing technologies to screen for chronic diseases, NYUCD researchers have begun to plan for the inclusion of routine saliva screening into dental practice, in particular the inclusion of HIV screening. A qualitative pilot study was conducted to assess the feasibility of implementing routine HIV saliva screening for patients seeking services in the NYUCD dental clinics. Ten key informant interviews were conducted with a purposive sample of dental faculty and staff and four focus groups with dental students to assess feasibility for integration of HIV saliva testing into practice. Interviews were audio-taped, transcribed verbatim and content analysis conducted to identify themes related to the study aims. Most dentists thought HIV saliva screening in the admissions clinic fit within the scope of dental practice and was an opportunity to contribute to public health. Barriers to implementation included lack of time, logistics, patient confidentiality, costs, reimbursement, lack of training in HIV testing and counseling, concerns about negative patient reactions. Significant opportunity exists for the integration of HIV saliva testing into dental practice. Development of training programs and policies and procedures are essential to implementation.