1. REGIONAL DIFFERENCES IN ACCESS TO DENTAL HYGIENE SERVICES FOR THOSE WITH HIV/AIDS IN CANADA McCarthy G. M., Mara T. W., Driessen C, Stitt L. W. Schulich School of Medicine & Dentistry, The University of Western Ontario; London, Canada BACKGROUND Dental hygienists have an important role in the provision of oral care for patients. People living with HIV/AIDS can be very vulnerable to oral infections and severe periodontal disease. Prevention, early detection and treatment of oral disease can reduce morbidity, improve prognosis and enhance quality of life. A national survey of dental hygienists in Canada was conducted to investigate attitudes regarding the treatment of patients with HIV, HCV or HBV; infection control practices and occupational exposures to blood. This poster focuses on access to dental hygiene services for patients with HIV / AIDS.OBJECTIVES To estimate the proportion of dental hygienists in different regions of Canada who report refusal to treat HIV patients. To investigate dental hygienists’ attitudes related to the treatment of HIV. RESULTS Characteristics of Respondents % Age20-3969 40-4923 ≥ 50 8 Region BC/NWT12 AB/SK/MB/YU12 ON45 QC24 NB/NS/PEI/NL 6 Training 2 yrs dental hygiene38 1 yr assisting+ 1 yr hygiene31 Other31 Year of graduation Pre 198012 1980-198916 1990-200372 DISCUSSION Refusal to treat HIV patients can result in charges of discrimination from professional or human rights organizations in Canada (Bergin, 2004) or elsewhere. Despite this, some health care workers are reluctant to treat. Across Canada, rates of refusal reported by dental hygienists ranged from 3% in BC and the NWT to 12% in Ontario. Fear of occupational exposure to HIV is an issue for many dental professional although the risk of HIV infection is <1%. Further investigation of Ontario hygienists indicated that 91% and 86% were willing to treat HIV and AIDS patients respectively - even though 50% believed that they would be placed at increased risk. In addition, 40% reported concern that they may lose other patients if they treated patients with HIV. Reports of an ethical responsibility to treat; knowledge of HIV and use of standard precautions were important predictors of non-refusal to treat patients with HIV/AIDS amongst hygienists in Canada. This confirmed previous findings from national studies of dentists (McCarthy et al, 1999), surgeons (McCarthy et al, 2005) and nurses in Ontario (McCarthy et al, 2006). Hygienists’ perception - that the dentist with whom they worked was willing to treat HIV patients- was also a major influence on acceptance of HIV patients for dental hygiene services. METHODS INSTRUMENT The questionnaire was developed and tested using focus groups, test-retest procedures and a pilot study (n=500) of hygienists in Ontario. Items in the questionnaire included sociodemographic variables, attitudes related to the treatment of HIV/AIDS patients, infection control procedures and continuing education. The final questionnaire was mailed to a stratified, random sample of 5,900 dental hygienists, licensed by their provincial or territorial colleges in Canada. The stratification was based on region. Follow up included two additional mailings. SAMPLE SIZE 5,900 REGIONS British Columbia and the North West Territories (BC/NWT). Alberta, Saskatchewan, Manitoba and the Yukon (AB/SK/MB/YU). Ontario (ON). Quebec (Q). Prince Edward Island, Nova Scotia, New Brunswick and Newfoundland (PEI/NS/NB/NL). DATA ANALYSIS Weighted data were analyzed using Pearson’s chi square tests. Significant variables were entered into a multiple logistic regression using SPSS/PC+. Weighting allowed for differences in probability of selection and non- response between the strata. (McCarthy et al, 1997) RESPONSE RATE WAS 56% Acknowledgements This study was supported by a grant from the Canadian Institutes of Health Research. TUPE0241 Predictors of Refusal to Treat % refusal Age (p=.009) 20-39 9 40-4913 ≥ 50 7 Training (p=.002) 2 yrs dental hygiene 7 1 yr as.+ 1 yr hygiene 13 Other 9 Year of graduation (p<.001) 1980-198915 pre1980/1990-2003 8 Continuing education infection control (p=.019) no hours 11 some hours 8 Dentist is reluctant to treat HIV patients (p <.001) yes 23 no 7 As a hygienist I have an ethical responsibility to treat patients with HIV (p=.001) disagree 20 agree 9 Use extra infection control procedures for patients with HIV (p<.001)sometimes/never 6 always 12 MULTIPLE LOGISTIC REGRESSION ANALYSIS Hygienists in Ontario were more likely to refuse to treat HIV patients than hygienists in other regions. Odds Ratio 4.2 (ref: BC/NWT) p=0.005 Other significant variables in the model included: year of graduation, continuing education on infection control in the last two years, dentists’ reluctance to treat patients with HIV, ethical responsibility to treat patients with BBPs and compliance with standard (universal) precautions. CONCLUSIONS Dental hygienists’ rates of refusal to treat patients with HIV differed significantly across Canada and were lowest in BC and the NWT and highest in Ontario.RECOMMENDATIONS Improvements in education on infection control (standard precautions), HIV/AIDS and ethics. Selection of more compassionate students for training in dental hygiene and dentistry Expansion of two year training program in dental hygiene. More research is required. References: McCarthy GM, Koval JJ. MacDonald JK. Factors associated with refusal to treat patients with HIV: The results of a national survey of dentists in Canada. American Journal of Public Health 1999; 89:541-5. McCarthy GM, MacDonald JK. Non-response bias in a national study of dentists’ infection control practices and attitudes related to HIV. Community Dentistry and Oral Epidemiology 1997; 25:119-25. McCarthy GM, Bednarsh H, Ssali CS et al. Transmission of HIV in the dental clinic and elsewhere. Proceedings of 4th International Workshop on Oral Manifestations of HIV Infection. Oral Diseases 2002; 8(suppl 2); 126-135. McCarthy GM, Harris K, Stitt L. Access to elective surgery for patients with HIV or other bloodborne pathogens in Canada. Ontario HIV Treatment Network Research Conference, November 24-25, 2005. Aragon C, McCarthy GM, Stitt L. Access to dental hygiene services for patients with HIV in Canada Ontario HIV Treatment Network Research Conference, 2005. Gillian McCarthy, Larry Stitt, Ken Harris, Michael John, Cornel Driessen. Attitudes of Ontario nurses related to the care of patients with HIV/AIDS. XVI International AIDS Conference 2006. Abstract # TUPE0247. Fiona Bergin. Duty to treat. Royal College of Dental Surgeons of Ontario Dispatch Oct/Nov 2004.