# Addressing Dental and Psychiatric Comorbidities: Screening and Referrals of HIV/AIDS Patients

> **NIH NIH R21** · UNIVERSITY OF ROCHESTER · 2024 · $231,000

## Abstract

Persons living with HIV/AIDS (PLWHA) are understudied and underserved with respect to both dental and
mental health services, compared to the general population. Psychiatric and dental comorbidities in PLWHA
result in diagnostic complexities, treatment gaps, increased health care costs and poorer outcomes. Early
diagnosis and treatment access are imperative. There are no US studies of co-occurring oral diseases and
mental illnesses in PLWHA. Assessment of treatment needs, self-management, and case management can
inform improved referral and treatment outcomes. Studies have identified barriers to dental care in PLWHA,
including ability to pay, dental anxiety, transportation, etc. Patients, HIV program directors, case managers and
administrators are key stakeholders in understanding PLWHA use of dental and mental health services. Their
referral success has not been assessed through traditional HIV surveillance. Factors for successful referral of
PLWHA to mental health and dental services are understudied. Examining linkage factors as perceived by
PLWHA, program directors and other staff, including the role of motivational Self-Determination Theory-based
(SDT) mechanisms is needed. The proposed study will examine factors related to referrals of PLWHA to dental
and mental health services and to describe the prevalence of comorbidities in 105 PLWHA, their self-
management, and their perception of case management. All patients (with or without co-morbidities) will be
assessed. The primary study outcome is keeping dental and/or mental health referral appointments.
AIM 1: To examine referral linkage factors (social, biological, or behavioral) in those screened for 1) oral
diseases only, 2) mental illness only, 3) both oral diseases and mental illness, or 4) neither (comparison
group). Other assessments include 8 key informant interviews (KIIs), 2 focus groups (FGs) with 8-12
participants each and validated surveys.
AIM 2: 2a) To describe the prevalence of comorbidities in a sample of PLWHA, the use of self-management
strategies and their referral need based on screening and clinical data (periodontal inflammation via salivary
biomarker IL-6 at baseline); 2b) To assess feasibility and obtain pilot data to inform a future motivation-based
intervention targeting oral and mental health behavior in PLWHA.
AIM 3: To examine health status at six months via patient screenings, clinical examination with salivary
biomarkers, and a survey.
Hypothesis: PLWHA screening positive for dental/mental comorbidities will keep fewer referral appointments
than those not screening positive. This could be associated with SDT motivational indices for referral and to
linkage factors. This innovative mixed-methods study will inform a needed evidence-base for patients, dental
and mental health professionals and other stakeholders, as well as future studies (e.g., a randomized clinical
trial) and potential interventions such as Motivational Interviewing strategies to maximize succes...

## Key facts

- **NIH application ID:** 10922852
- **Project number:** 5R21DE032871-02
- **Recipient organization:** UNIVERSITY OF ROCHESTER
- **Principal Investigator:** Sangeeta Gajendra
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $231,000
- **Award type:** 5
- **Project period:** 2023-09-06 → 2026-09-05

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10922852

## Citation

> US National Institutes of Health, RePORTER application 10922852, Addressing Dental and Psychiatric Comorbidities: Screening and Referrals of HIV/AIDS Patients (5R21DE032871-02). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10922852. Licensed CC0.

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