Massachusetts Improves Access to Oral Health Services for People Living with HIV/AIDS
Regular oral health care is important to a person’s overall health, as oral diseases can cause pain and disability. Some Americans have difficulty accessing oral health care services, including PLWHA, due to barriers such as limited incomes, lack of insurance, and availability of dental practitioners.1 Additionally, PLWHA have more unmet oral health care needs than the general population. For many years, PLWHA have reported high rates of unmet oral health care needs and low utilization of oral health services.2 When paired with weakened immune systems, lack of dental care puts many PLWHA at a higher risk for oral diseases and compromised well-being.3 A visit to the dentist may be a health care milestone for PLWHA. The dental professional can address oral health concerns and play a role in helping engage or reintroduce patients into the health care system and coordinate their care with other primary care providers.3
In 1991, the HIV Dental Ombudsperson Program (HIV DOP) was created within the Boston Public Health Commission as a comprehensive dental access program to remove or reduce barriers that prevented PLWHA from receiving oral health services. The HIV DOP receives approximately $1.7 million from the Boston Eligible Metropolitan Area (EMA) Part A from the Health Resources and Services Administration (HRSA) Ryan White Program and the Massachusetts Department of Public Health, of which 65% goes to reimbursement for dental services provided. The program consists of various components including client enrollment and referrals, provider recruitment, and HIV oral health care education. Throughout Massachusetts and three counties in Southern New Hampshire, PLWHA may self-enroll in the HIV DOP or are enrolled by a case manager or medical or dental provider. Approximately 40 clients are enrolled on a monthly basis. Additionally, the program refers enrolled HIV-positive clients to a network of dental providers who provide oral health services; recruits dental providers who are sensitive to the needs of PLWHA and willing to provide confidential treatment to patients regardless of their HIV status; and educates consumers, dental students, and providers on HIV oral health. As an advocate for PLWHA and oral health care professionals, the program investigates any potential discrimination by dental providers and assists clients with problems they may experience in accessing dental services.4
Over the past 24 years, more than 15,000 unique clients have enrolled in the HIV DOP. In its first year, the program enrolled 10 providers and 400 clients. Currently, there are over 200 providers and 5,000 clients actively enrolled, with approximately 1,600 unique clients receiving 7,000 services annually. The program captures data on clients’ health and quality of life in the past six months, including details on medical adherence, housing status, mental health status, CD4 count, and viral load. In February 2016, 90.5% of HIV dental service clients were virally suppressed, 90.5% were stably housed, and 84.5% described excellent adherence to HIV-related medications. On the other hand, only 79.2% of non-dental service clients of agencies funded by the Boston EMA were virally suppressed, 61.8% were stably housed, and 61.7% described excellent adherence to HIV-related medications.
Barriers to accessing oral health care, such as low health literacy and lack of transportation, continue to exist for PLWHA. The HIV DOP understands the importance of case management, specifically for keeping clients engaged in the program, and the importance of maintaining strong relationships with dental offices that aid in client follow-up and serve as a resource for new clients. Moving forward, the program plans to expand services for adult dental care; continue efforts to reach more dental providers and promote the program; and develop a dental data module to simplify provider reimbursements, tracking of services, and client information. The HIV DOP will continue to increase access to oral health care services for vulnerable populations, including PLWHA; encourage routine dental visits instead of emergency-based care; and educate consumers, students, and providers on HIV oral health care.
HIV Dental Ombudsperson Program
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