Point of care HIV testing in the dental setting: An acceptability and feasibility study

BACKGROUND: 
\nIn the UK, upwards of 100,000 people are living with HIV. However, undiagnosed and late diagnosis of HIV remains a public health problem. Around 4,660 (5%) people living with HIV are undiagnosed, and almost half are diagnosed late (CD4+ <350cells/uL). Expanded HIV testing in non-traditional healthcare settings has played an important part in the public health response to eliminating HIV transmission. In the US and Canada, implementing HIV testing interventions into dental settings has shown promise.
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\nAIM: 
\nThe aim of this study was to determine the feasibility and acceptability of implementing HIV point of care testing (HIV POCT) in UK dental settings. The findings aimed to inform parameters for a full-scale trial and determine whether progression to a full-scale trial was appropriate. 
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\nMETHODS: 
\nThe study comprised two phases. Phase I encompassed a mixed methods systematic review and qualitative research used to explore the attitudes of dental professionals, dental patients and people living with HIV toward HIV POCT in dental settings. In Phase II, HIV POCT intervention was implemented in dental practices in London alongside an embedded process evaluation.
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\nRESULTS: Phase I: The systematic review identified multiple approaches to delivering HIV POCT in dental settings. The focus groups indicated that universal HIV POCT integrated into dental settings was appropriate and acceptable for implementation in the UK. Further, training needs around HIV knowledge and communication skills were identified. 
\nPhase II: 441 patients were offered HIV testing, 48.1% accepted. Patients found the intervention highly acceptable. However, most perceived themselves at low risk of HIV infection. Recruitment diminished significantly over time and required ongoing research support. Local adaptation of the intervention was common and undermined intervention delivery. 
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\nCONCLUSIONS: 
\nInsurmountable logistical barriers, poor fidelity, persistent recruitment issues, and data collection challenges meant that the intervention was not considered feasible for progression to full-scale trial.

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