ETE Interventions in the Dental Setting

Study Overview
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Brief Summary
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The purpose of this study is to use information technology (IT) to support the delivery of HIV prevention and care best practices in the dental care setting to meet the Department of Health and Human Services (DHHS) Ending the HIV Epidemic (ETE) goals.

Detailed Description
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Routine HIV screening in all health care settings is considered a best practice by the Centers for Disease Control and Prevention (CDC), DHHS Ending the Epidemic Initiative, the New York State Blueprint to End the AIDS Epidemic, and is mandated by law in New York for all individuals over the age of 13 who receive hospital or primary care. Despite this, many patients are not screened for HIV during routine care, including in dental care settings, resulting in missed opportunities for identifying undiagnosed HIV infections, providing education for and linkage to PrEP, and linking and re-engaging HIV-positive patients into HIV care. The investigators will use information technology in the following two ways to support the delivery of HIV prevention and care best practices in the dental care setting to meet the DHHS Ending the HIV Epidemic (ETE) goals. First, Dental Teams will receive a Best Practice (BPA) alert whenever they have a patient who should be offered HIV testing. This BPA is linked to an order set to simplify ordering HIV tests and reporting results. Second, Dental teams will be contacted whenever they have a patient who is known to have HIV and is out of HIV care. A critical knowledge gap for implementing these ETE activities in the dental setting is whether comprehensive ETE efforts could be integrated into existing dental teams consisting of practitioners, dental assistants and hygienists or require augmentation by a dedicated care navigator. Therefore the investigators will pilot the Dental Team and Care Navigator models at two different dental sites (NYP-Columbia and NYP-Weill Cornell) using a cross-over design to evaluate acceptability and feasibility of providing HIV prevention and treatment services supported by these health IT strategies in the dental setting under these two care delivery models. If the strategies are found to be acceptable and feasible for both dental care patients and providers, then the study will expand to 4 sites and examine the effectiveness of these strategies for delivering HIV prevention and care best practices in the dental setting.

Official Title
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Effectiveness of Comprehensive Ending the Epidemic (ETE) Interventions in the Dental Setting

Conditions
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HIV Infections

Intervention / Treatment
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* Other: Care Navigator
* Other: Health Information Supported Ending the HIV Epidemic (ETE) Activities in Dental Setting


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Dental Team/Patient Navigator: To be eligible, members of the Dental Team or Patient Navigator need to have direct contact with patients at a participating dental clinic site during the months of the pilot study. Patient: To be eligible, patients must: Be 18 years or older Have at least one visit during the months of the pilot study at a participating dental clinic Exclusion Criteria: Not meeting inclusion criteria

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Non-Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Each site will experience a care delivery model for 3 months, followed by a 1 month washout period, and then 3 months with the alternative care delivery model.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Placebo Comparator: Dental Team<br>ETE activity implementation with existing Dental Team only (i.e. practitioners, dental assistants, hygienists) | Other: Health Information Supported Ending the HIV Epidemic (ETE) Activities in Dental Setting<br>* Dental Teams will receive a Best Practice Alert (BPA) when they have a patient who should be offered HIV testing. Dental Teams will also be notified when they have a patient known to be HIV positive but out of HIV care.<br>|
| Active Comparator: Care Navigator<br>ETE activity implementation with additional Care Navigator resource | Other: Care Navigator<br>* The Dental Team will have a Care Navigator as an added resource to assist with offering, implementing, and counseling for HIV testing; providing PrEP education and linkage; and providing linkage and re-linkage to HIV care.<br>Other: Health Information Supported Ending the HIV Epidemic (ETE) Activities in Dental Setting<br>* Dental Teams will receive a Best Practice Alert (BPA) when they have a patient who should be offered HIV testing. Dental Teams will also be notified when they have a patient known to be HIV positive but out of HIV care.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptability among Patients | Acceptability of the intervention under the two arms will be assessed using the validated Acceptability of Intervention Measure (AIM). AIM is a 4-item scale where respondents rate each item using a 5-point ordinal scale that ranges from completely disagree=1 to completely agree=5. The AIM is scored by averaging responses across the 4 items. A higher average score indicates greater acceptability, which is a better outcome. | Within 2 weeks after the patient's dental visit | 
| Acceptability among Providers | Acceptability of the intervention under the two arms will be assessed using the validated Acceptability of Intervention Measure (AIM). AIM is a 4-item scale where respondents rate each item using a 5-point ordinal scale that ranges from completely disagree=1 to completely agree=5. The AIM is scored by averaging responses across the 4 items. A higher average score indicates greater acceptability, which is a better outcome. | Within 2 weeks after the patient's dental visit | 
| Feasibility among Providers | Feasibility of the intervention under the two arms will be assessed using the validated Feasibility of Intervention Measure (FIM). FIM is a 4-item scale where respondents rate each item using a 5-point ordinal scale that ranges from completely disagree=1 to completely agree=5. The FIM is scored by averaging responses across the 4 items. A higher average score indicates greater feasibility, which is a better outcome. | Within 9 months from baseline | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Health Information Technology, Care Navigation, Acceptability, Feasibility, Dental Setting