Carrigan Parish, DMD, PhD

Oral Health Related Quality of Life and Unmet Dental Needs among Reproductive Aged Women with HIV

Carrigan L Parish, DMD, PhD; Yue Pan, PhD; Nicholas Fonseca Nogueira, MPH; Deborah L Jones, PhD; Apoena Ribeiro DDS, MS, PhD; Patricia Del Carmen Raccamarich, MD; Elizabeth F Topper, PhD; Daniel Westreich, PhD; Aadia Rana, MD; Seble Kassaye, MS, MD; Deborah Konkle-Parker, PhD, FNP, FAAN; Anandi N Sheth, MD, MSc; Maria Alcaide, MD

Dr. Parish: Columbia University, New York, NY
Dr. Pan: University of Miami, Miami, FL
Mr. Fonseca Nogueira: University of Miami, Miami, FL
Dr. Jones: University of Miami, Miami, FL
Dr. Ribeiro: University of North Carolina, Chapel Hill, NC
Dr. Raccamarich: University of Miami, Miami, FL
Dr. Topper: Johns Hopkins University, Baltimore, MD
Dr. Westreich: University of North Carolina, Chapel Hill, NC
Dr. Rana: University of Alabama-Birmingham, Birmingham, AL 
Dr. Kassaye: Georgetown University, Washington DC
Dr. Konkle-Parker: University of Mississippi Medical Center, Jackson, MS
Dr. Sheth: Emory University, Atlanta, GA
Dr. Alcaide: University of Miami, Miami, FL

 

Women with HIV (WWH) of reproductive age encounter many barriers leading to oral health disparities, including caregiving responsibilities, eclipsing medical needs, and financial barriers that impede routine, preventive dental care. Oral health-related quality of life (OHRQOL) is a multidimensional, perception-based measure of how oral health impacts social and physical functioning and self-image. Understanding oral health conditions and OHRQOL among reproductive age WWH is critical to identify unmet dental needs and related health implications.

The Study of Treatment And Reproductive outcomes (STAR) is a prospective, observational cohort study of reproductive-aged WWH and women without HIV (WWOH) conducted in 6 Southern cities. Participants (N = 518; 354 WWH/164 WWOH) completed semiannual study visits using structured interviews to capture oral health data and the 5-item Oral Health Impact Profile (OHIP) to assess OHRQOL. This analysis examines oral health and OHRQOL stratified by HIV status.

Participants’ median age was 35 [range 18–45] years. Less than half of women had received dental care in the past year (47.2% WWH/45.1% WWOH; p=0.624). Approximately one-third of women reported having a dental problem but did not seek treatment (30.2% WWH/31.1% WWOH; p=0.208), with the most common reason being uninsured or unable to afford dental care (15.0% WWH/18.9% WWOH; p=0.264). More WWOH self-reported their oral health status as being excellent/good (51.9% WWOH/43.2% WWH; p=0.204). The mean OHIP score [range 0 – 20] for WWH (4.09, standard deviation (SD) = 4.85) trended higher (reflecting worse OHRQOL) than that of WWOH (3.13, SD = 4.02; p=.095).

Study findings show suboptimal use of dental care and high unmet needs in reproductive age WWH, specifically in the setting of financial barriers, and potentially worse OHRQOL compared to WWOH. Dental assessments and OHRQOL administered in HIV research settings can identify significant dental treatment needs in the context of HIV infection. Assessing factors that affect oral health in these populations provides critical information on unmet dental needs and identified gaps should guide care delivery. The relationships between dental needs, OHRQOL, and other indices of HIV and general health have important clinical implication and are key to understanding oral health among WWH.