BUSPH Researchers Complete Extensive Evaluation of Oral-Health Care Programs for People With HIV/AIDS.
Boston University School of Public Health researchers recently concluded key roles in a five-year evaluation of oral health care models for people with HIV/AIDS that could help expand oral health services to other vulnerable populations.
The findings of the federally-funded Innovations in Oral Health Care Initiative were presented in a Public Health Reports special supplement lauded as “the most comprehensive additions to the body of knowledge about oral health care for people living with HIV/AIDS since the HIV Cost and Services Utilization Study conducted nearly a decade ago.”
BUSPH was the evaluation and support center for the initiative, a designated “Special Project of National Significance” funded by the Health Resources and Services Administration arm of the U.S. Department of Health and Human Services.
The project encompassed 15 sites across the nation, split among urban and rural settings, with the goal of developing and evaluating methods of increasing access to oral health care for people with HIV/AIDS.
Jane Fox, project director of the Evaluation Center for HIV and Oral Health (ECHO) at the BUSPH Health and Disability Working Group (HDWG), said the ECHO team focused its input in several critical areas: technical assistance to help establish care sites, a multi-site evaluation of demonstration projects, and the final research and dissemination of findings such as the special supplement.
“This is an excellent snapshot,” Fox said. “We have another document that we’re publishing that shows additional aspects of what we’ve learned, along with a cost piece to show other clinics what they can expect.”
In addition to Fox, members of the BU team included Carol Tobias, director of the HDWG and an assistant professor of health policy management; Sara Bachman, co-principal investigator for ECHO center and an associate professor of social research at the BU School of Social Work; Angela Walter, HDWG research assistant; and Serena Rajabiun, HDWG senior evaluator.
Programs were tailored for each of the individual locations to handle myriad concerns such as privacy, access, and coordination with established health care service providers. A site run by Tenderloin Health in San Francisco integrated oral health care into an existing multidisciplinary program of HIV/AIDS health services, Fox said. The Tenderloin Center even explored the unusual step of setting up a homeless drop-in center to build trust among clients and increase follow-up care.
After collecting and evaluating the data, Fox said one of the biggest ongoing questions is, “How do we transfer the knowledge that we gained here to other populations? The problems that we encountered here aren’t specific to HIV populations. They’re actually common across many vulnerable populations.”
One of the upcoming publications using the collected data will center on findings from multiple sites that used dental case managers, Fox said. Nine of the 15 sites hired a dental case manager to schedule patients, arrange transportation or lodging when needed, and assist in booking procedures.
“Dental case management for vulnerable populations is pretty cutting edge. In some cases, dental assistants were trained to be dental case managers. In other cases, they used HIV case managers who then had to be trained on the dental side,” Fox said.
Policy changes expected in coming years could make the oral-care findings even more relevant, Fox said. The current reauthorization of the Ryan White Care Act provides funds for oral health care and treatment for people living with HIV/AIDS, but will expire in 2013, when most of the benefit recipients will be moved into health plans covered by the Affordable Care Act.
“We’re in a prime position to inform people that ACA doesn’t cover dental care for a lot of these folks, and dental care consistently comes up as an unmet need,” Fox said.