Dentists' Willingness to Provide Expanded HIV Screening in Oral Health Care Settings

Results From a Nationally Representative Survey

Harold A. Pollack, PhD; Margaret Pereyra, DrPH; Carrigan L. Parish, DMD; Stephen Abel, DMD, MSO; Shari Messinger, PhD; Richard Singer, DMD, MS; Carol Kunzel, PhD; Barbara Greenberg, PhD, MSc; Barbara Gerbert, PhD; Michael Glick, DMD; Lisa R. Metsch, PhD


Am J Public Health. 2014;104(5):872-880. 

In This Article


Among the 2876 dentists contacted, 328 were determined to be ineligible (either because of type of practice or expired or revoked dental license), 11 submitted incomplete surveys, and 735 were nonresponders (explicit refusals, unable to be located, or unavailable). In total, 1802 dentists completed interviews, for a response rate among eligible dentists of 70.7%. Most respondents completed the interviews via mail (n = 1349), and the rest responded via telephone (n = 28), fax (n = 30), Internet (n = 381), or in person (n = 14). A total of 1392 respondents completed the survey and received the standard incentive payment; an additional 31 received the $50 incentive. A total of 379 completed the survey after receiving the $100 maximum incentive payment.

Table 1 summarizes selection probabilities by survey strata. Base weights (the ratio of the initial sample frame to the total frame count within each stratum) greatly varied across strata, underscoring the need for weights to obtain unbiased descriptive statistics that generalize to the full dental population. Response rates also varied by age and by other respondent characteristics. We computed probability weights that adjusted for such nonresponses.

Table 2 shows descriptive characteristics of our study sample. As noted in the "Methods" section, we computed descriptive statistics to account for the weighted and stratified nature of the sample.

The majority of respondents were male (78.3%) dentists employed in private group dental practices (65.4%) who did not accept Medicaid as a dental insurer (71.6%). Whites were the most represented racial/ethnic group (78.6%); they were also the least willing of all the races/ethnicities to offer rapid testing and the least likely to accept this testing as part of the dentist's professional role.

Only 14 of 1802 dentists reported that they were currently offering HIV rapid testing, and these individuals exhibited significant agreement that doing so is part of the dentist's professional role (67.6%). Fewer than 1 in 8 dentists appeared familiar with the 2006 revised CDC guidelines that recommend routine HIV screening of adults in US outpatient health care settings.

Dentists' attitudes about the importance of generalized, widespread HIV testing (assessed by agreeing with a statement about the "importance for all persons 13 years and older to get tested at least once") and their prior experience recommending HIV testing to patients were significantly associated with their willingness to offer oral rapid testing and accepting this as part of the dentist's role. Having patients with a known positive serostatus, however, was not a significant factor.

The perceived normative expectations of others were especially influential in the bivariate analysis; respondents' willingness to offer testing and acceptance of it as part of their profession were significantly correlated with agreement that, if they were to offer testing, (1) patients would be accepting of HIV testing in the dental setting, (2) colleagues' perceptions of them would improve, and (3) patients' perceptions would improve, and disagreement with the statement that they would be concerned about negative reactions from patients.

Clinical knowledge and previous training in HIV disease were not significantly associated with dentists' willingness to offer rapid HIV testing. They were, however, significantly associated with acceptance of HIV testing as part of the dental professional's role.

Table 3 shows our multiple logistic regression results. Dentists who agreed that provision of rapid oral screening would improve their professional standing among colleagues reported greater willingness to screen (odds ratio [OR] = 1.57; 95% confidence interval [CI] = 1.16, 2.11) and more acceptance of HIV testing as part of their role (OR = 1.93; 95% CI = 1.42, 2.62). Similar patterns existed regarding the perceived preferences of dental patients; those who strongly agreed that patients' perceptions of them would improve were more than 4 times as likely to perceive this testing as part of their role, whereas those who strongly disagreed were significantly less likely to offer HIV rapid testing willingly (OR = 0.18; 95% CI = 0.07, 0.46) or to accept testing as part of the dentist's role (OR = 0.06; 95% CI = 0.02, 0.25).

Dentists who perceived the greater public health urgency of HIV testing (assessed by agreeing that it is "very important" that all persons 13 years and older be tested for HIV at least once) were more likely to report that they were willing to provide such testing (OR = 1.56; 95% CI = 1.16, 2.10), and that rapid oral HIV testing is consistent with the dental role (OR = 1.81; 95% CI = 1.35, 2.45). Dentists who had in fact already recommended that a patient get tested for HIV in the past were more likely to accept this testing as part of their professional role (OR = 1.52; 95% CI = 1.12, 2.06).

African American dentists were more than twice as receptive as Non-Hispanic White dentists (OR = 2.18; CI = 1.24, 3.81) to rapid oral testing as part of the dentist's role. Older dentists appeared marginally more receptive to regarding rapid oral testing as part of the dentist's role (OR = 1.01; CI = 1.00, 1.03), although this attitude was not accompanied by greater apparent willingness to offer rapid oral testing.

Dentists practicing in non–Ryan White "micropolitan" and rural areas appeared less willing to perform HIV testing, a finding consistent with lower overall HIV prevalence in such communities. ADA members appeared slightly less embracing of oral rapid HIV screening on 3 of the 4 measures; however, odds ratios were not statistically significant for these associations. Dentists' perceived clinical knowledge of treating patients with HIV also appeared to be an important variable, with "good" and "excellent" clinical knowledge associated with greater embrace of testing.

We also found reduced willingness to screen among dentists who required higher incentive payments to participate in the survey. Those requiring $100 to participate were notably less willing to perform rapid HIV screening (OR = 0.71; CI = 0.55, 0.94) than those who required less of an incentive. In bivariate comparisons, dentists requiring higher incentive payments were 9 percentage points less willing to provide rapid oral HIV screening.

Finally, the amount of training dentists received in HIV testing and counseling appeared to be associated both with willingness to provide and acceptance of HIV testing as part their professional role. Dentists with more than 8 hours of training had almost twice the odds of being willing to provide testing (OR = 1.92; CI = 0.98, 3.77) and to embrace testing as part of the dental role (OR = 1.78; CI = 0.91, 3.49).