Utilization of oral health services and barriers among HIV patients visiting public and private health facilities in Kampala Capital City, Uganda

Abstract

Introduction: The greatest burden of oral diseases is offered by the destitute and socially relegated populaces like People Living with HIV and AIDS (PLWHAs). This eventually hints to discomfort and anguish, wearying of function and effect on quality of life all depending on their stage of HIV disease(Ajayi and Arigbede, 2012). Investment in Oral health care is very critical for improving quality of life, management of complicated HIV medical conditions, better nutrition and psych-social support for HIV patients. .

Objectives: The main objective of this study was to determine the level and barriers to utilization of the Oral Health Care Services among patients attending selected public and private HIV Clinics in order to inform future programming for PLWHAs.

Research Methods: A cross sectional study in which adult People Living with HIV and AIDS (PLWHAs) were systematically sampled at the selected public and private HIV Clinics. Data were collected by trained research assistants through interviews using a semi-structured questionnaire, records review, and both qualitative and quantitative analysis were conducted. For quantitative analysis, Univariate, Bivariate and Multi variable analysis were done to determine associated factors with oral dental care utilization. Qualitatively, Key Informant Interviews (KIIs) were held with Dental Practitioners and HIV/AIDs In-Charges at ART clinics.

Results: In total 412 (98.8%) were reached with the survey, with more females 295 (71.6%) compared to the males 117 (28.4%). Majority 220(53.4%) of the respondents interviewed were aged 18-34 years and most of whom are Baganda representing 259 (62.9%). The median age was 33 years (mean 34.7 years, SD ± 9.6). Interestingly, most patients were married/cohabiting 192(46.6%) followed by those who were single 132 (32.5%). According to results from this study, 68.4% of the patients did not visit a medical practitioner or dentist for oral health checkup or treatment within the past 12 months, while only a third of the patients (31.6%) did. At bivariate analysis, individual factors that were significantly associated with not using OHS included; Perceived Need Factors: [Concerns with Confidentiality (p<0.05), Fear and Discomfort with dental instruments, Self-perceived need (p<0.001), and Selfreported satisfaction with Oral Health Status (OHS)]; Predisposing factors: [Experience of any dental/oral problems in the past 12 months (p<0.001), Oral Health Treatment Source and Time on ARVs (p<0.05)] and Health System Factors: [Cost of Services (p<0.05) and Experienced Long waiting time (p<0.01)]. Note that none of the socio demographic or enabling factors was significant. At multivariable analysis, the factors that were found to be significantly associated with not using OHS were; being female(PR=1.16, 95% CI 1.02 to 1.32), Not having an experience of dental/oral problems in the past 12 months (PR=2.16, 95% CI 1.83 to 2.54), Longer time on ARVs (PR=1%, 95% CI 1.00 to 1.02), and Preference to attend a Private facility (PR=0.86, 95% CI 0.75 to 0.97).

Conclusions and Recommendations: People living with HIV/AIDs (PLWHAs) are vulnerable to Oral diseases. Results from this study have shown that a considerable proportion are experiencing barriers to utilization of OHS. In addition, the Andersen Model of Health Care Utilization enabled the investigator identify the significant predictors of these barriers, which were mainly the predisposing including the socio-demographic, perceived need, and health system factors. However, there is a paucity of studies related to this, yet interventions/ decisions regarding oral health interventions for PLWHAs should be based on evidence. This calls for further research on appropriateness, efficiency, acceptability, effectiveness, and equity of oral/dental services among PLWHAs.