Dental Care Improves Health Outcomes of HIV Patients with Substance Use Disorders

Those living with HIV and who abuse drugs experience worse health outcomes than those who aren't using. However, a study conducted mid-2021 reported those with HIV who abused drugs and have not had dental care use, experience a greater need of care.

With or without dental care, folks who have HIV and use drugs experience worse health outcomes than their non-using counterparts because substance use can speed disease progression, affect adherence to antiretroviral therapy, and worsen the overall consequences of HIV.

The clinical trial, Project HOPE (Hospital as Opportunity for Prevention and Engagement for HIV Infected Drug Users) sought to improve engagement in HIV outcomes, according to researcher and co-author of the study, Anthony J. Santella, DrPH, MCHES. Santella is also professor of Health Administration and Policy, director of the Doctorate of Health Sciences program for the School of Health Sciences, and University COVID-19 Coordinator.

"As a researcher, I used this dental utilization data to assess factors associated with dental care utilization among Project HOPE participants, with a research question focused on understanding the relationship between sociodemographic, HIV care, and risk factors with routine dental care utilization among PLWH (people living with HIV) with substance use disorders," Santella said.

The analysis was part dome with data from a large, national clinical trial of just over 800 people living with HIV with substance use disorders who were inpatients at 11 urban hospitals. In the trial, dental care use was measured at each time point during the study period (baseline, 6 months and/or 12 months).

It was found that over half (59.4%) reported not having received any dental care at any time point.

Santella shared those with HIV-related symptoms and an AIDS diagnosis have a greater need for dental care than those with fewer symptoms and without AIDS, but eclipsing needs for physical and mental health services limit their access to dental care.

He added access to oral health programs has shown to improve physical and mental health. In a sample of low-income people living with HIV, engagement in an oral health program was associated with improvement in overall wellbeing.

In relation to the study, many variables of social determinants of health (SDoH) were looked at to find solutions in HIV care.

For example, participants with less than high school education had lower odds of reporting dental care utilization than those with more than education. Data also revealed those without health insurance also had lower odds of reporting dental care utilization than those with insurance. Higher food insecurity was also associated with having recent dental care utilization as were those from Southern states.

In the study, food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS) which consists of nine items measuring one’s experience with insecure food access - each item scored on a scale of 0 to 3 where 3 represents the highest frequency of occurrence.

Data found participants who had higher food insecurity had greater odds of reporting recent dental care. Findings from a retrospective analysis of National Health and Nutrition Examination Survey data found an association between food insecurity and unmet dental needs, which may be directly due to oral health problems causing trouble with eating. While the results differ, the dental setting represents an often untapped, but potentially useful venue in the provision of patient education in the subject of food insecurity, he Santella added.

It's recommended that the association between food insecurity and dental care utilization among this population needs further exploration.

Overall, having more access to dental care can better the outcomes of HIV patients who have substance use.

"The mouth is the gateway to the body," Santella said. "Oral health impacts physical health and physical health impacts oral health. Having access to quality, affordable dental care may mean a person is more likely to be linked to and engaged in care which should lead to better health outcomes."

"Research has shown a synergic relationship between oral health and wellness, so the more we can promote oral health in people with HIV (including those who use drugs), the better off they will be in maintaining quality of life."