D2 DENT 8004 HIV Lecture Dec 2024 PDF

D2 DENT 8004 Practice Essentials and Interprofessional Education Module IV Person Centered Care Persons Diagnosed with HIV Wednesday, December 11, 2024 Dr. Melanie E. Mayberry, D.D.S., M.S.-HCM, Fellow, Academy of G...

D2 DENT 8004 Practice Essentials and Interprofessional Education Module IV Person Centered Care Persons Diagnosed with HIV Wednesday, December 11, 2024 Dr. Melanie E. Mayberry, D.D.S., M.S.-HCM, Fellow, Academy of General Dentistry Amanda Allmacher, DNP, NP-C, Associate Director, Michigan AETC, Courtney M. Mucklin, Program Coordinator, Michigan AETC Wayne State University School of Medicine Patient Panelists DENT 8004 Practice Essentials and IPE, Module IV Learning outcomes, today’s session: Recognize that certain disease states and other patient factors may marginalize affected persons from receiving oral and general health care and list examples and apply to clinical cases via case-based scenarios Discuss and understand the epidemiological impact of persons with HIV Discuss and understand the prevalence of caries and periodontal disease in persons diagnosed with HIV as compared to the general population Describe and identify barriers, using clinical case-based scenarios, this and similar populations may encounter to receiving Describe and apply, using clinical case-based scenarios, person management, dental management, and oral disease prevention strategies Mayberry, DDS, MS-HCM 2024  ’ s session: tion for today Informa fe spa ce Sa ation Info rm ns , before dge k questi o no w le e s s ts , a s K c tu a l awaren t w i t h patien h i c h y o u are le Intel nal awarenes s i t no w , interac fe elings in w tio a bout s and room Emo y to th in k e em oti on s i gn ed O p portunit in ic -m ay hav t fo r y o ur as to the c l s. See lis you g e t ti en t. o m s w ith pa e o unawar en breakout r L e c ture th HIV Mayberry, DDS, MS-HCM 2024  oul d feel? H A ? t o th er w tin g PLW i g n ifican ion: t tre a , or s f le ct b o u us e Pre re you feel a y , sp o o u? a m il k e y How do fr i e n ds, f n ’ t l ook li in k y our s th at do d o you th g p e rson How ut t r eatin l abo H o w p do yo oor? s? u f e e HIV A r e les o m e Are h BTQ? L Are G r? a ge? ot? o ld e ng u o r n Are f o re ign la n e c e ssity a g Speak bias trainin re? it a Implic n patient c to Impac Mayberry, DDS, MS-HCM 2024 HIV Mayberry, DDS, MS-HCM 2024  HIV Medical Overview Detailed medical management including lab interpretation has been covered in previous lectures or will be covered in subsequent lectures. Mayberry, DDS, MS-HCM 2024  HIV Human Immunodeficiency Virus can lead to acquired immunodeficiency syndrome; AIDS Retrovirus Spread through certain body fluids Attacks the body’s immune system; CD4 / T cells HIV can destroy so many of the CD4 cells making the body defenseless against infections, diseases, cancers, and opportunistic infections Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/basics/  HIV Medications Common compliance barriers Trouble swallowing pills Busy schedule Work and travel Being sick or depressed Treatment fatigue- sometimes difficult to stick to recommended plan over time Side effects Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/basics/whatishiv  HIV Medications Common side effects Nausea and vomiting Diarrhea Difficulty sleeping Dry mouth Headache Rash Dizziness Fatigue Pain With newer ARTs most patients experience side effects that are mild and manageable Most patients can control their HIV infection by taking one or two pills daily Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/basics/whatishiv  HIV Treatment involves taking medicines that slow the progression of the virus in the body Combination drug therapy; antiretroviral therapy (ART) ART reduces the amount of virus or viral load in the blood and body fluids. Viral suppression to undetectable can be achieved in 6 weeks U=U: Undetectable equals untransmittable Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/basics/whatishiv  HIV Today there is “PrEP” Truvada, a combination of two drugs, tenovir and emtricitabine. Taken daily, medicine in bloodstream For those at high risk for HIV Stops HIV infection Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/basics/prep.html Mayberry, DDS, MS-HCM 2024 Epidemiology Mayberry, DDS, MS-HCM 2024  Epidemiology “Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems.” Mayberry, DDS, MS-HCM 2024 JM, ed. Dictionary of Epidemiology, Third edition. New York: Oxford U. Press, 1995:55.  Epidemiology “Epidemiology is the study of the distribution and determinants of disease frequency in man.” The who, what, when, and why Mayberry, DDS, MS-HCM 2024 MacMahon B., Pugh TF. Epidemiology: principles and methods. Boston: Little Brown and Company, 1970:1.  Epidemiology Prevalence Incidence The proportion of persons in a population who have a The occurrence of new particular disease or attribute cases of disease or injury at a specified point in time or in a population over a over a specified period of specified period of time. time. Includes all cases, both new and preexisting, in the population at the specified time, whereas incidence is limited to new cases only. Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson3/section2.html  HIV-Epidemiology Canada This information was provided by the Canadian AIDS Treatment Information Exchange (CATIE). For more information, contact CATIE at 1-800-263-163M8a.yberry, DDS, MS-HCM 2024  HIV-Epidemiology Canada This information was provided by the Canadian AIDS Treatment Information Exchange (CATIE). For more information, contact CATIE at 1-800-263-163M8a.yberry, DDS, MS-HCM 2024  HIV-Epidemiology U.S. Today, estimated 1.1 million people are living with HIV in the U.S. In 2015, 38,500 new HIV infections Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/pdf/statistics/overview/cdc-hiv-us-ataglance.pdf  HIV-Epidemiology U.S. Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/pdf/statistics/overview/cdc-hiv-us-ataglance.pdf  HIV-Epidemiology U.S. Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/pdf/statistics/overview/cdc-hiv-us-ataglance.pdf  HIV-Epidemiology U.S. Nearly half of people in the United States living with diagnosed HIV are aged 50 and older. Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/pdf/group/age/olderamericans/cdc-hiv-older-americans.pdf  HIV-Epidemiology Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/pdf/group/age/olderamericans/cdc-hiv-older-americans.pdf  HIV-Epidemiology U.S. Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/pdf/group/age/olderamericans/cdc-hiv-older-americans.pdf  HIV-Epidemiology Mayberry, DDS, MS-HCM 2024 https://www.cdc.gov/hiv/pdf/group/age/olderamericans/cdc-hiv-older-americans.pdf The Oral Health Systemic Connection Mayberry, DDS, MS-HCM 2024  HIV Predisposes to certain oral health problems HIV-related oral conditions occur in 30-60% of patients with HIV In pediatric patients one of the most common finding is candidiasis Xerostomia is the most common in adult and pediatric patients Oral disease prevention is key Mayberry, DDS, MS-HCM 2024 American Dental Association. Center for Scientific Information. ADA Science Institute. 2017  Periodontal Disease-Epidemiology Mayberry, DDS, MS-HCM 2024 https://www.perio.org/consumer/cdc-study.htm  Caries-Epidemiology Caries Root Caries 91% of adults in the Major cause of tooth loss in the elderly. U.S. 20-64 years had dental caries Prevalence of root caries among dentate adults between the ages of 50 and 64 was 27% have untreated 30.8%, dental decay compared to 10.4% among adults ages 20 to 34.7 The high prevalence of root caries among middle-aged and older adults in the U.S. is a major public health issue. Mayberry, DDS, MS-HCM 2024 Chi D., Shyue C. Preventing and Managing Root Caries. The Journal of Multidisciplinary Care. Decisions in Dentistry. 2016(3) Caries: https://www.cdc.gov/nchs/data/databriefs/db197.htm Root Caries elderlyhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4930634/  HIV-Oral Clinical Manifestations Oral health problems are common among PLWHA (People living with HIV/AIDS) Higher incidence of caries and periodontal disease 90% will have at least 1 oral manifestation attributed to HIV infection.* Xerostomia predisposes to dental caries, periodontal disease, and fungal infections Mayberry, DDS, MS-HCM 2024 * C. Parish, K. Siegel, M. Pereyra, T. Liguori, L. Metsch. Barriers and facilitators to dental care among HIV-Infected adults. Spec Care Dentistry. 2015 35(6) https://www.hrsa.gov/sites/default/files/publichealth/clinical/oralhealth/hivfactsheet.pdf  HIV-Oral Clinical Manifestations PLWHA have more unmet oral health care needs than does the general population. PLWHA also have more unmet oral health care needs than unmet medical needs Mayberry, DDS, MS-HCM 2024 Health Resources and Service Administration (HRSA)  HIV-Oral Clinical Manifestations Dry mouth Karposi’s syndrome Thrush Outbreak of Herpes Simplex Virus White lesions on the sides of Canker sores the tongue (Oral Hairy Leukoplakia) Mouth ulcers Red band gingivitis Xerostomia Ulcerative periodontitis Burning Mouth syndrome Mayberry, DDS, MS-HCM 2024 American Dental Association.  HIV-Oral Clinical Manifestations National Institute of Dental and Craniofacial Research www.nidcr.nih.gov National Institutes of Health Department of Health and Human Services. NIH Publication No. 04-5320 March 2004 Mayberry, DDS, MS-HCM 2024  HIV-Oral Clinical Manifestations National Institute of Dental and Craniofacial Research www.nidcr.nih.gov National Institutes of Health Department of Health and Human Services. NIH Publication No. 04-5320 March 2004 Mayberry, DDS, MS-HCM 2024  HIV-Oral Clinical Manifestations Clinical Medical management is covered in detail in other lectures. Such as: Lab considerations (neutrophil, platelets CD4, WBC) Antibiotic use Mayberry, DDS, MS-HCM 2024  HIV-Dental Management Prevention is key Nutrition counseling Through health, medical, medication, dental history Consideration of medical labs Caries risk assessment Perio risk assessment Oral Cancer Screening Assessment for xerostomia Tobacco cessation awareness and counseling Mayberry, DDS, MS-HCM 2024 Medical Consult ACP Amorphous Calcium Phosphate Mayberry, DDS, MS-HCM 2024  HIV We see a lot of PLWHA in our clinics, Corktown and UHC. The Ryan White Funds/dental programs defrays a significant amount of oral health care expenses. We participate in this program and have been able to meet the oral health needs. Mayberry, DDS, MS-HCM 2024 PLWHA: Persons Living with HIV/AIDS  HIV-Oral Clinical Manifestations 58-64% of PWLHA do not receive regular dental care. WHY?? Mayberry, DDS, MS-HCM 2024 Health Resources and Service Administration (HRSA)  HIV You may ask why not focus on patients with TB, or Hepatitis, the common cold, or now Coronavirus? Mayberry, DDS, MS-HCM 2024  HIV-Oral Clinical Manifestations 58-64% of PWLHA do not receive regular dental care. Barriers Lack of insurance Limited income Lack of providers Limited awareness Stigma Mayberry, DDS, MS-HCM 2024 Health Resources and Service Administration (HRSA)  HIV Stigma. No other medical diagnostic group faces the extent of stigma like PLWHA. Not TB Not Hepatitis Not the flu or the common cold or any other infectious disease. And not Coronavirus causing COVID-19….. Mayberry, DDS, MS-HCM 2024  HIV-Stigma and Discrimination “HIV-Related stigma refers to negative beliefs, feelings and attitudes towards PLWHA, their families, people who work with them (HIV service providers), and members of groups that have been heavily impacted by HIV, such as gay and bisexual men, homeless people, street youth, and mentally ill people.” Mayberry, DDS, MS-HCM 2024 CDC  HIV-Stigma and Discrimination Unfair and unjust treatment of someone based on their real or perceived HIV status. Can be institutionalized laws policies practices Mayberry, DDS, MS-HCM 2024 CDC  HIV-Stigma and Discrimination Per Link and Phelan (2006) stigma involves 5 intertwined components: Labeling Reflection Stereotyping Self Awareness High EQ Social exclusion Essential characteristics for effective health care providers Discrimination Power relations Mayberry, DDS, MS-HCM 2024 Brondani M., Phillips C., Kerston P., Moniri N. Stigma Around HIV in Dental Care: Patients’ Experiences. J Can Dent Assoc. 2016;82:g1  HIV-Stigma and Discrimination World Health Organization (WHO) 3 phases of HIV/AIDS epidemic The HIV epidemic The AIDS epidemic The epidemic of stigma-discrimination- denial, which has a negative impact on life and well being Mayberry, DDS, MS-HCM 2024 Brondani M., Phillips J., Kerston R., Moniri N. Stigma Around HIV in Dental Care: Patients’ Experiences. J Can Dent Assoc. 2016;82:g1  HIV-Stigma and Discrimination Because of the impact of stigma and discrimination many initiatives have been developed and implemented. The Ryan White HIV/AIDS Program The Housing Opportunities for Persons with AIDS Federal program The Affordable Care Act (ACA) A law to ensure that Americans have secure, stable, and affordable health insurance. Created several changes to expand access to coverage for people with HIV. Mayberry, DDS, MS-HCM 2024 CDC  HIV-Stigma and Discrimination Washington state law requires dentists, dental hygienists, and dental assistants to complete 7 clock hours of HIV/AIDS training. Mayberry, DDS, MS-HCM 2024 Washington State Dental Association  HIV-Stigma and Discrimination Patients may be reluctant to seek help and health care due to: Fear Judgment Rejection Stigmatization Mayberry, DDS, MS-HCM 2024 Brondani M., Phillips J., Kerston R., Moniri N. Stigma Around HIV in Dental Care: Patients’ Experiences. J Can Dent Assoc. 2016;82:g1  HIV-Stigma and Discrimination PLWHA may be dealing with: Self stigma Fear Internalized shame Guilt Public stigma Past misdemeanors during encounters with dental care professionals Mayberry, DDS, MS-HCM 2024 Brondani M., Phillips J., Kerston R., Moniri N. Stigma Around HIV in Dental Care: Patients’ Experiences. J Can Dent Assoc. 2016;82:g1  HIV-Stigma and Discrimination Stigma has been shown to impact mental health factors for PLWHA. Anxiety Depression Suicidal ideation Emotional health Psychological wellbeing Life satisfaction Quality of life Treatment compliance Mayberry, DDS, MS-HCM 2024 Chambers L., Rueda S., Baker N., Wilson M., Deutsch R., et al. Stigma, HIV and health: a qualitative synthesis. BMC Public Health. 2015 (15):848  HIV-Stigma and Discrimination According to research there is a cognitive and affective dimensions (and behavioral and attitudinal) to health care provider stigma-discriminatory practice behavior. Mayberry, DDS, MS-HCM 2024 Brondani M., Phillips J., Kerston R., Moniri N. Stigma Around HIV in Dental Care: Patients’ Experiences. J Can Dent Assoc. 2016;82:g1  HIV-Stigma and Discrimination Emotions can overpower rational decision making. This is why stigma reduction training and intervention is so necessary for health care providers Must include relaying knowledge about HIV and its transmission and transmission risks Must include, acknowledge, and address the emotional aspects of health care providers as well. Mayberry, DDS, MS-HCM 2024 Brondani M., Phillips J., Kerston R., Moniri N. Stigma Around HIV in Dental Care: Patients’ Experiences. J Can Dent Assoc. 2016;82:g1  HIV-Stigma and Discrimination HIV stigma can be additive and synergic to other stigmas such as poverty, poor, sex, drug use, homelessness, race, and sexual orientation. Mayberry, DDS, MS-HCM 2024 Re-thinking HIV-Related Stigma in Health Care Settings: A Qualitative Study.2015. Journal of the Association of Nurses in AIDS Care. Gagnon M.  HIV-Stigma and Discrimination Research shows that health professionals who hold stigmatizing attitudes towards PLWHA commonly manifest it in clinical encounters. Mayberry, DDS, MS-HCM 2024 Beyond negative attitudes: Examining HIV/AIDS stigma behaviors in clinical encounters. November 2017  HIV-Stigma Next year you will be in the clinic. How do you feel about treating PLWHA? How do you think your friends, family, spouse, or significant other would feel? Mayberry, DDS, MS-HCM 2024 The Results Mayberry, DDS, MS-HCM 2024 Qualtrics Post reflection activity questionaire due this Monday. Link will be sent today. Mayberry, DDS, MS-HCM 2024 DENT 8004 Practice Essentials and IPE, Module IV You should now be able to: Recognize that certain disease states and other patient factors may marginalize affected persons from receiving oral and general health care and list examples and apply to clinical cases via case based scenarios Discuss and understand the epidemiological impact of persons with HIV Discuss and understand the prevalence of caries and periodontal disease in persons diagnosed with HIV as compared to the general population. Describe and identify barriers, using clinical case based scenarios, this and similar populations may encounter to receiving. Describe and apply, using clinical case based scenarios, person management, dental management, and oral disease prevention strategies Mayberry, DDS, MS-HCM 2024  Acknowledgements / Resources / References Patient panelists Mary Rose Forsyth, MSN, NP Mary Parise, DDS Centers for Disease Control and Prevention (CDC) Canadian AIDS Treatment Information Exchange (CATIE). American Dental Association. Center for Scientific Information. ADA Science Institute. 2017 Chi D., Shyue C. Preventing and Managing Root Caries. The Journal of Multidisciplinary Care. Decisions in Dentistry. 2016(3) Health Resources and Service Administration (HRSA) National Institute of Dental and Craniofacial Research www.nidcr.nih.gov National Institutes of Health Department of Health and Human Services. NIH Publication No. 04-5320 March 2004 Brondani M., Phillips C., Kerston P., Moniri N. Stigma Around HIV in Dental Care: Patients’ Experiences. J Can Dent Assoc. 2016;82:g1 Washington State Dental Association Chambers L., Rueda S., Baker N., Wilson M., Deutsch R., et al. Stigma, HIV and health: a qualitative synthesis. BMC Public Health. 2015 (15):848 HIV-related stigma in the dental setting: a qualitative study. N. Patel, J. Furin, D. Willenberg, N. Apollon Chirouze, L. Vernon. Spec Care Dentistry. 2015. 35(1) C. Parish, K. Siegel, M. Pereyra, T. Liguori, L. Metsch. Barriers and facilitators to dental care among HIV- Infected adults. Spec Care Dentistry. 2015 35(6) Re-thinking HIV-Related Stigma in Health Care Settings: A Qualitative Study.2015. Journal of the Association of Nurses in AIDS Care. Gagnon M. 26(6) 703-719 Please note: commercial businesses noted in videos, lectures, or slides are not an endorsement of the company. They are used only to provide specific topic explanations or demonstrations. Internet images are credited where credit is noted. Mayberry, DDS, MS-HCM 2024