1. Greater Baltimore HIV Heath Services
TO EVALUATE THE LOW UTILIZATION OF ORAL HEALTH SERVICES BY BENEFICIARIES OF RYAN WHITE PART-A PROGRAM Capstone Project, Gurpreet Kaur, DDS MPH Epidemioloy University of Maryland
Greater Baltimore HIV Heath Services
Planning Council
Patrick Chaulk, MD, MPH

2. Consequences of poor dental health
Gum disease
Tooth decay
Tooth erosion
Mouth sores
Tooth sensitivity, aches and emergencies
Oral cancer
Cosmetic needs
Bad breath
Negative impact on healthy diet
Dental and mouth problems related to HIV can be painful, which can cause trouble chewing or swallowing. This may prevent you from taking your HIV medication. It can also result in malnutrition, as you may have trouble eating and absorbing enough essential nutrients. A compromised digestive system may affect the absorption of your HIV drug treatment.
Reference:

3. Consequences of HIV and oral health
Increased susceptibility to dental infections
Mouth: first body part to be affected by HIV infection
People with HIV may experience:
Dry mouth
Thrush/Candidiasis
Oral hairy leukoplakia
Red band gingivitis
Kaposi’s sarcoma
HSV-1 infections
Mouth ulcers
(Pakfetrat et. al., 2015)
Dental and mouth problems related to HIV can be painful, which can cause trouble chewing or swallowing. This may prevent you from taking your HIV medication. It can also result in malnutrition, as you may have trouble eating and absorbing enough essential nutrients. A compromised digestive system may affect the absorption of your HIV drug treatment.
Reference:

4. Data collection CAREWare, 2017 data Nature of data collected
Administrative
Clinical
Support service data
Tabular reports completed annually by Ryan White grantees and their subcontractors

5. Sample size Total= 12,462 Duplicates= 10 Sample Size= 12,452
Inclusion criteria: patients receiving medical, non-medical or support services under Ryan White Part-A program

6. Oral health care services utilization
Outcome variable
Oral health care services utilization
Had an oral health visit
Did not have an oral health visit

7. Age AGE (in years) 02-24 13-24 25-45 46-65 >65 N (%) 31 (0.25)
471 (3.78)
4193 (33.67)
6886 (55.30)
871 (7.00)
Baseline sociodemographic characteristics of the study sample can be found in Table 1. Participants ranged in age from 03 to 91 years with a mean age of years (48.03土13.25). The majority of the sample was male (61.8%). Participants who identified themselves as black comprised of 77.14% of the sample, followed by those who identified as white (14%). About 41% of the study participants were covered under Medicaid for their health insurance followed by Medicare (20.1%) and 20% of the study population had private insurance. Approximately 7% of the sample had no insurance. The majority of the population reported an annual household income in the range of $0 to $20,000 (71.9%). Majority of the participants reported having a stable housing status (72.4%). The study sample that was virally suppressed was 89.4% (having a viral load of less than 200 HIV virus copies). Additionally, majority of the population was also retained in care (63.9%).

8. Gender GENDER Male Female Transgender Unknown N (%) 7693(61.78)
4562 (36.63)
154 (1.24)
43 (0.35)
Baseline sociodemographic characteristics of the study sample can be found in Table 1. Participants ranged in age from 03 to 91 years with a mean age of years (48.03土13.25). The majority of the sample was male (61.8%). Participants who identified themselves as black comprised of 77.14% of the sample, followed by those who identified as white (14%). About 41% of the study participants were covered under Medicaid for their health insurance followed by Medicare (20.1%) and 20% of the study population had private insurance. Approximately 7% of the sample had no insurance. The majority of the population reported an annual household income in the range of $0 to $20,000 (71.9%). Majority of the participants reported having a stable housing status (72.4%). The study sample that was virally suppressed was 89.4% (having a viral load of less than 200 HIV virus copies). Additionally, majority of the population was also retained in care (63.9%).

9. Race & Ethnicity
RACE & ETHNICITY
White
African-American
Hispanic
Other
Not Specified
N (%)
1739 (13.96)
9605 (77.14)
401 (3.22)
466 (3.74)
241 (1.94)

10. Insurance Status
Medicaid
Medicare
Private
Other
Unknown
No Insurance
5123 (41.14)
2501 (20.08)
2490 (20.00)
170 (1.37)
1310 (10.52)
858 (6.89)

11. Income Status INCOME $0 - $20,000 $21,000 - $40,000 $41,000 - $60,000
>= $61,000
Missing Value
N (%)
8879 (71.87)
1250 (10.12)
498 (4.03)
1727 (13.98)
98 (0.007)

12. Oral health visits
ORAL HEALTH VISITS
Did not have a visit
Had a visit
N (%)
10332 (82.97)
2120 (17.03)

13. Population Characteristics Based on Access to Oral Health Visits
STUDY VARIABLES
TOTAL
N=12452
DID NOT HAVE ORAL HEALTH VISIT N=10332
HAD ORAL HEALTH VISIT
N=2120
P-VALUE
Age (in years)
02-12
13-24
25-45
46-65
>65
31 (0.25)
471 (3.78)
4193 (33.67)
6886 (55.30)
871 (6.99)
30 (96.77)
449 (95.33)
3633 (86.64)
5514 (80.08)
706 (81.06)
1 (3.23)
22 (4.67)
560 (13.36)
1372 (19.92)
165 (18.94)
<0.0001
Race & Ethnicity
White
African-American
Hispanic
Not Specified
Other
1739 (13.97)
9605 (77.14)
401 (3.22)
241 (1.94)
466 (3.74)
1464 (84.19)
7965 (82.93)
334 (83.29)
180 (74.69)
389 (83.48)
275 (15.81)
1640 (17.07)
67 (16.71)
61 (25.31)
77 (16.52)
0.0085
Gender
Female
Male
Transgender
Unknown
4572 (36.64)
7693 (61.78)
154 (1.24)
43 (0.35)
3788 (83.03)
6366 (82.75)
140 (90.91)
38 (88.37)
774 (16.97)
1327 (17.25)
14 (9.09)
5 (11.63)
0.0453

14. Population Characteristics Based on Access to Oral Health Visits
STUDY VARIABLES
TOTAL
N=12452
DID NOT HAVE ORAL HEALTH VISIT N=10332
HAD ORAL HEALTH VISIT
N=2120
P-VALUE
Insurance
Medicaid
Medicare
Private
Other
Unknown
No Insurance
5123 (41.14)
2501 (20.09)
2490 (20.00)
170 (1.37)
1310 (10.52)
858 (6.89)
4262 (83.19)
1947 (77.85)
2147 (86.22)
152 (89.41)
1261 (96.26)
563 (65.62)
861 (16.81)
554 (22.15)
343 (13.78)
18 (10.59)
49 (3.74)
295 (34.38)
<0.0001
Housing
Stable
Unstable
9009 (73.35)
704 (5.65)
2739 (22.00)
7504 (72.63)
608 (86.36)
2220 (81.05)
1505 (16.71)
96 (13.64)
519 (18.95)
0.0011
Income
$0.00-$20,000
$21,000-$40,000
$41,000-$60,000
>=$61,000
8879 (71.87)
1250 (10.12)
498 (4.03)
1727 (13.98)
7490 (84.36)
1068 (85.44)
400 (80.32)
1292 (74.81)
1389 (15.64)
182 (14.56)
98 (19.68)
435 (25.19)

15. Findings Oral health utilization is low Barriers: Income Insurance
Viral loads
Not retained in care
Protective factors
Age
Public insurance: Medicaid, Medicare, Ryan White
Of the total 12,452 participants only 2120 individuals had an oral health visit, individuals did not avail any of the oral health services provided under RWHAP
Lower income groups were almost twice likely to not utilize oral health services compared to people with higher incomes
The participants in the unknown category were almost 5 times more likely to not utilize oral health care services
People who we

16. Next Steps Utilization is low, but why?
Is there a provider capacity issue?
MSA versus jurisdictions
Best practices local and national
Focus group and key informant interviews and/or surveys
Clients
Providers
Develop effective education campaign: clients and providers
Identify potential partners:
State pilot program for dual eligibles
University of Maryland Dental School
Maryland Dental Association