A Standardized Patient Approach to Measuring and Reducing Negative Attitudes Toward People with HIV and Substance Use Disorder among Dental Care Providers to Improve Care Outcomes

About This Grant

PROJECT SUMMARY/ABSTRACT This project will use a novel standardized patient (SP) approach to more objectively measure negative attitudes toward people with HIV (PWH) and people with substance use disorder (SUD) in dental settings in Kazakhstan (KZ). This information will be used to inform development of a sustainable care improvement intervention for dental providers in KZ. KZ has one of the world's fastest growing HIV epidemics, primarily driven by substance use. HIV-related oral conditions adversely impact PWH's health and adherence to antiretroviral therapy (ARn, problems that are compounded for HIV-positive people who use drugs (PWUD). Oral health problems and unmet dental needs are common among PWH, and PWUD also have a high prevalence of oral health problems (e.g., xerostomia-induced dental caries, candida, tooth loss). Although dentists are responsible for treating the many oral consequences of HIV and substance use, they report minimal, if any, training and knowledge in HIV and patient substance use. Yet, their professional role has evolved to include some primary care, such as chairside medical screenings (e.g., screening for ART adherence and SUD). Negative attitudes toward PWH and people with SUD are key barriers to dental care for PWH and PWUD in KZ, especially for those with co-occurring conditions; yet research on care improvement interventions for dental providers has largely been absent. Study aims are: 1) identify drivers and manifestations of negative attitudes toward PWH, PWUD, and individuals with co-occurring conditions among dental providers using nominal group technique and a refined unannounced SPbased visit method to obtain a baseline assessment of these negative attitudes in 16 KZ dental clinics; 2) develop an intervention that will increase screening for ART adherence and SUD by dental providers; and 3) conduct a pilot cluster-randomized control trial assessing intervention feasibility, acceptability, and preliminary impact on dental providers' a) negative attitudes toward PWH, PWUD, and individuals with co-occurring conditions, and b) screening for ART adherence and SUD. This proof-of-concept study will advance methodologies that more objectively assess negative attitudes among providers, enabling us to examine differences in having one health condition versus two and to explore whether co-occurring negative attitudes have additive, multiplicative, or some other combined effect. Including SPs with HIV and/or SUD as co-evaluators in assessing negative attitudes and as co-developers and co-implementers of the resulting intervention will advance the field of HIV and SUD intervention development that can improve HIV continuum of care outcomes for populations with co-occurring conditions. Findings will inform design of a future large-scale R01 trial to rigorously evaluate the effectiveness of SP-driven interventions in dental settings.