Oral Health as an Integral Part of HIV/AIDS Care Continuum

1University of California - Los Angeles, Los Angeles, CA, 2Los Angeles County HIV Commission, Los Angeles, CA, 3Consultant, Ashville, NC

Objectives: Oral health is an integral component of the complex continuum of HIV/AIDS care and yet significant barriers to accessing and utilizing oral health services continue to exist. The most effective service delivery lies in a continuum of care that coordinates core medical and support services specific to each patient's needs. Our objective was to develop a county-wide continuum of care model that corresponds to the wide range of ethnicities, social identities, risk behaviors, clinical needs and service expectations of people living with HIV/AIDS (PLWHA).

Methods: Based on the systems planning concept of “stocks” and “flows,” a “population flow map” was developed for over 63,000 PLWHA who live in Los Angeles County. This map illustrates pathways that individuals, with varying degrees of HIV risk or infection, take through the care system. The process to develop this new continuum of care began with more than 60 local care, treatment and prevention stakeholders in April/May 2007. From there, representatives from several agency-based, academic and government-funded dental programs participated in developing a “service map” for dental care. The process was repeated for all other HIV-related service clusters. All “service maps” -interventions- were linked with “population flow map” -patient status in care system- and “process and structural indicators” –factors influencing patient's entry into care, treatment adherence, etc- as well as “health outcomes and indicators” were added to further define the continuum of care model. Finally a Wenn Diagram was developed to illustrate the relationship between the continuum, the community, standards and funding and resources.

Results: The continuum of care model and indicators were developed outlining what features of the services have the most influence on the effective service delivery and improved health/lifestyle outcomes.

Conclusion: This continuum of care is an important planning tool for evidence-based decision-making and targeted goal-setting with shrinking resources and increasing HIV positive populations.