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 Table of Contents  
ORIGINAL RESEARCH
Year : 2017  |  Volume : 9  |  Issue : 6  |  Page : 284-288

Knowledge, attitude, and practices of dental students toward human immunodeficiency virus/acquired immunodeficiency syndrome of AMC Dental College and Hospital, Ahmedabad, Gujarat: A cross-sectional study


1 Department of Public Health Dentistry, AMC Dental College and Hospital, Ahmedabad, Gujarat, India
2 Interns, AMC Dental College and Hospital, Ahmedabad, Gujarat, India

Date of Web Publication20-Dec-2017

Correspondence Address:
Dr. Ashish S Sharma
30, Kunj Homes, Near Rameshwar School, Nikol Naroda Road, Nava Nikol, Ahmedabad - 382 350, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jioh.jioh_231_17

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  Abstract 

Aims: This study aimed to evaluate the knowledge and awareness of the dental students regarding human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) and HIV testing in routine dental practice.
Materials and Methods: It is a cross-sectional survey, in which 267 students from 3rd year, 4th year, and interns of B.D.S at AMC Dental College and Hospital participated voluntarily. A close-ended questionnaire with multiple-choice questions was designed for this survey. Chi-square test was used for statistical analysis using SPSS version 20 software.
Results: In this study, we found that >90% of the participants have overall adequate knowledge about HIV/AIDS, there were inadequacies in terms of testing, treatment, and therapy. The participants showed positive attitude toward people living with HIV/AIDS (PLWHAs), but the results also indicate that the dental students are not well equipped to treat HIV/AIDS patients though sympathetic. One of the key findings is that >80% of students are in favor of using rapid HIV testing in clinical setup as screening test.
Conclusion: Dental students must be made aware of and should understand the importance of treating HIV/AIDS patients. This can be achieved by proper modeling and making the students more sensitized toward PLWHAs as well as introduction of routine HIV testing kits at dental setups.

Keywords: Acquired immunodeficiency syndrome, cross-sectional survey, human immunodeficiency virus


How to cite this article:
Sheth S, Sharma AS, Mehta SK, Kachwala H, Parker N, Pandya D. Knowledge, attitude, and practices of dental students toward human immunodeficiency virus/acquired immunodeficiency syndrome of AMC Dental College and Hospital, Ahmedabad, Gujarat: A cross-sectional study. J Int Oral Health 2017;9:284-8

How to cite this URL:
Sheth S, Sharma AS, Mehta SK, Kachwala H, Parker N, Pandya D. Knowledge, attitude, and practices of dental students toward human immunodeficiency virus/acquired immunodeficiency syndrome of AMC Dental College and Hospital, Ahmedabad, Gujarat: A cross-sectional study. J Int Oral Health [serial online] 2017 [cited 2022 Jan 26];9:284-8. Available from: https://www.jioh.org/text.asp?2017/9/6/284/221258


  Introduction Top


Human immunodeficiency infection is a fatal condition in which the immune system's cells are attacked by the human immunodeficiency virus (HIV), making it weak and prone to opportunistic infections. Acquired immunodeficiency syndrome (AIDS) is the more severe stage of the infection. The oral cavity is comprised of many surfaces, each coated with various fluids which are a host to a plethora of microorganisms. This makes a dentist prone to occupational infection as we are dealing with these sensitive structures day in and day out, thus putting us at a risk for acquiring HIV and other infectious diseases.[1] Around 36.7 million people were estimated worldwide to be affected by it. India ranks third worldwide with about 21.7 lakh [2] affected by the condition. The report also stated that most of the HIV-infected individuals in India remain undiagnosed.

There is a conscious effort to control this HIV epidemic in India through various testing mechanisms. Early diagnosis becomes important in cases of HIV-positive cases to prevent the spread of infection in the society. Dentistry can play a significant role in this as it is a recognized branch of health care where a large part of the society is dealt with on a daily and regular basis.[3]

The oral cavity can play a leading role in monitoring the progression of HIV infection through identification of specific lesions, which are often found earlier in weak immune system (such as oral candidiasis and oral hairy leukoplakia). An estimation of 90% is given in cases of HIV infection where through the course of disease at least one or more of these oral lesions are found. Dentists can easily identify such lesion and can help in the early diagnosis of the HIV infection.

Aims

The aim of the present study was to evaluate the knowledge, attitude, and practices of the dental students regarding HIV or AIDS and the use of rapid HIV testing kit in dental practice.

Objectives

  • To evaluate the knowledge, attitude, and practices of the dental students regarding HIV/AIDS
  • To evaluate the possibility of using rapid HIV testing kits for screening test in routine dental practice.



  Materials and Methods Top


Study design

It is a cross-sectional survey, in which 267 students from 3rd year, 4th year, and interns of B.D.S at AMC Dental College and Hospital participated voluntarily.

Ethical consent

Ethical approval for the study was obtained from the institutional ethical review board of AMC Dental College and Hospital. The ethical approval letter number is AMC/IRB/20217. The written permission from the Dean of AMC Dental College and Head of Department of Public Health Dentistry was taken prior to the survey.

Time scale and place of study

The proposed study was conducted on March 9, 2017 at AMC Dental College and Hospital, Khokhara, Ahmedabad. The day was selected based on feasibility and availability of the participating students.

Selection criteria

  • Inclusion criteria:


    1. The students of 3rd year, 4th year, and interns studying B.D.S at AMC Dental College and Hospital were only included
    2. The students present on the day of survey were only considered for the study
    3. The participants willing to give informed consent were included in the study
    4. Completely filled questionnaires were only considered for data analysis.


  • Exclusion criteria:


    1. The students absent on the day of the survey were excluded
    2. The participants not willing to give informed consent were not considered for the study
    3. Incompletely filled questionnaires were not considered for the study.


Materials/Equipment for the study

  1. An informed consent form
  2. A participant information sheet along with self-administered, close-ended structured questionnaire comprising 10 close-ended multiple-choice questions (MCQs) designed for this survey
  3. No equipment were used for this study.


Method for collection of data

A close-ended questionnaire with MCQs was designed for this survey to assess and analyze the knowledge and mindset of dental students studying in the third and final years of the undergraduate dental surgery course and the interns at AMC Dental College and Hospital, Ahmedabad, Gujarat, India, toward HIV or AIDS [Survey Questionnaire] [Additional file 1].

The students were explained in detail regarding the study on the prescribed day of the survey. An informed consent form along with participant information sheet was made to be filled from individual participants prior to the survey.

The students filled the questionnaire during a 20-min session. The questionnaire was designed by the product information under the guidance of the Public Health Department. The completely filled questionnaires along with informed consent forms were then collected by principal investigator on the same day and incompletely filled questionnaires were not considered for the study. All the students participated voluntarily in the study and were informed that participation would not affect their grade. All participants were asked to report about their gender, age, and year of study.

The questionnaire included 14 close-ended questions to evaluate the knowledge of HIV infection. Participants had the options of correct and incorrect to answer the questions.

The collected data were then entered in the master chart prepared in Microsoft Excel 2010 in the computer at the end of the study. The Chi-square test was used for statistical analysis using SPSS version 20 (IBM, Armonk, New York, USA) software.


  Results Top


The total number of participants from 3rd year was 94, final year was 90, and 81 were interns, of which the total number of female participants from 3rd year was 63, final year was 61, and 58 were interns. The total female-to-male ratio was 2:1 as referred in [Table 1]. The question asked to the students was about their knowledge about transmission of HIV or AIDS to which 98.87% replied correctly while 1.13% students did not answer the question, indicating about them being not aware while we did not find any significant difference in the basic knowledge among the students as shown in [Table 2]. The question asked to the students was about their main concern about treating people living with HIV/AIDS (PLWHAs) for dentist to which 73.4% of students answered that undetected HIV-positive patient appears like a normal healthy person while 2.99% students felt that the cost of personal protection equipment is the concern and 17.6% were concerned about the sterilization of instruments, and also 2.24% of students incorrectly felt about learning new procedure while 3.74% did not answer the question, suggesting their inadequate knowledge as referred in [Table 2]. For the question asked to the students regarding their knowledge about the prevention of transmission of HIV, 94.7% of respondents answered correctly, 4.56% of the students answered incorrectly and 0.74% students did not answer the question, suggesting their inadequate knowledge as referred in [Table 2]. The question asked to the students was about their experience of treating or examining a PLWHA to which only 26.59% of the total students have come across known cases, of which 61.72% were interns while 73.4% of the total participants did not have any experience of examining or treating a PLWHA which in our study showed that there is a significant statistical correlation with higher level of education as interns had more experience of clinical practice as referred in [Table 2]. The question asked to the participants was about their plan for treating a PLWHA if they come across them to which 69.66% of students plan to treat them with caution in an isolated room while 6.36% planned to refer these patients to a specialist and 16.10% admitted that they did not have the knowledge or experience for treating PLWHA, and also 4.11% answered in correctly stating that they would treat the same as noninfected person as referred in [Table 2]. The question asked to the participants was about if they have ever referred a suspected case for HIV after oral examination to which only 20.59% of students have referred a case while 79.41% of students have not referred any case for HIV testing which in our study we found had statistical significance with interns having more experience of referring suspected cases as referred in [Table 2]. The question asked to the participants was about their plan to protect themselves from unknown case of HIV to which 91.38% of students felt that the use of personal protective barriers such as gloves and mask are sufficient and 5.24% students felt the need to screen each and every person using rapid HIV testing or other test before any treatment while 3.37% students did not feel the need to take any precaution or special plan to protect themselves as referred in [Table 2]. The question asked to the participants was regarding the reason for carrying out screen test for HIV in clinical practice to which 86.51% students felt for early diagnosis and to prevent cross-contamination between infected person and dentist and other patients, 4.49% students felt to prevent contamination from infected patient to noninfected, 3.74% felt that for early diagnosis prescreening is required while 4.86% of students felt that it should be done to prevent infection to a dentist from infected patient as referred in [Table 2].
Table 1: Gender and education details of study participants

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Table 2: Statistical interpretation of questionwise responses by study participants

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In the next part of survey, we asked the students slightly advanced questions on testing and therapy part. The question asked to the students was about the window period of HIV to which 50.93% answered correctly by choosing 3 weeks to 6 months and all the rest of the students answered incorrectly choosing 1 week to 10 days (11.23%), 14 days to a month (23.97%), and a year (13.85%) as referred in [Table 2], but we found that in this question interns had more knowledge than the final year and 3rd year students with P < 0.005 as shown in [Table 2]. The question asked to the participants was about their knowledge regarding the fate of CD4 count in HIV cases to which 60.67% answered correctly stating that count decreases and 17.22% answered incorrectly by stating that count increases while 22.09% stated that they were not aware regarding the count as referred in [Table 2]. The question asked to the participants was about their knowledge regarding confirmatory test for HIV after positive ELISA to which 58.8% answered correctly by stating Western blot while the rest answered incorrectly by choosing 26.59% CD4 count test, 1.49% for rapid HIV testing while 13.1% stated that they were not aware regarding the confirmatory testing as referred in [Table 2]. The question asked to the students was regarding their knowledge about postexposure therapy in case of occupational exposure from sharp instruments and equipment following the National AIDS Control Organization (NACO) protocol to which only 31.46% were aware about postexposure prophylaxis,[4] while the rest answered incorrectly by choosing preexposure prophylaxis 12.35%, antiretroviral therapy 52.43%, and 5.24% were not aware as referred in [Table 2]. The question asked to the participants was regarding their knowledge to a place for referring their patient for HIV testing or counseling (integrated counseling and testing center [ICTC]) to which 62.54% students were aware about the center while 37.46% were not aware of the same as referred in [Table 2].

One of the highlight findings in our study was regarding raid HIV testing kit, so the question asked to the students was their opinion on using rapid HIV test kits as a screening test in dental setting to which 83.52% showed positive response for its use while 16.48% were not in favor of its use as referred in [Table 3].
Table 3: Opinion for using rapid HIV testing kit in dental practices

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  Discussion Top


The future path regarding rapid HIV testing in dental settings should be further investigated using other studies and we should also evaluate the challenges in the implementation of the testing.

Rapid HIV test kit is a useful tool in screening HIV-positive patients which is noninvasive taking only swab of the oral mucosa or saliva or invasive by drawing of blood sample and gives rapid result between 20 and 40 min as obvious from our study that around 80% of dental students are willing to use this routine HIV test kit in their clinical practice.

Even though it is a useful test, there are many obstacles in implementing this in clinical dental setting.[5] It can give false-negative results in window period or even after that, so it is not foolproof and in cases of positive results the patient is referred for other tests.

It should be made cost-effective to be implemented in mass in public or private hospitals if it is to be made mandatory for every patient. Government subsidies and other policy changes, i.e., in NACO, and national and oral health policies are required for its implementation even in small-scale pilot program to see the results and also make changes in national insurance policy.

The results of our study were compared with the study by Patil-Srineevasan-Goel conducted in Meerut as referred in [Table 4], in which, the sample size used was 219 dental students, of which 46 students were studying in the 3rd year dental course, 112 students in the final-year course, and 61 were intern while the male-to-female ratio was 1:3. In contrast to that, in the present study, the sample size was 265 dental students, of which from 3rd year were 94, final year were 90, and 81 were intern, while the total number of female participants from 3rd year was 63, final year was 61, and 58 were intern. The total male-to-female ratio was 1:2. The total mean knowledge score in this study was 76.5% (excellent knowledge), while the present study showed similar results in terms of mean for knowledge which is 71.61%. The study by Patil-Srineevasan-Goel showed that the overall mean attitude score was 62.9% (negative attitude); while in our study, the students showed positive attitude with mean score of 90.85%. In this study, a majority of the students, irrespective of their year of study, showed negative attitude toward PLWHA, while in the present study, the dental students showed highly positive attitude toward treating PLWHAs in clinical practices with overall mean attitude score. The level of knowledge was associated significantly with the year of study in this study, a finding that differs from the present study. Fear of HIV contagion has been found to be the primary reason behind the negative attitude and unwillingness of dental students and dentists to treat HIV/AIDS patients in this study in contrast to the present study, where in spite of the student having concern about asymptomatic or apparently healthy person being HIV infected, they showed positive response as referred in [Table 4].
Table 4: Comparison of present study with Patil-Srineevasan-Goel's study

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It would become a moral and ethical duty for a dentist to explain to a patient in case of positive rapid test result for referring him/her to an ICTC for further testing.

This study proves to be of vital importance in assessing the basic knowledge, attitude, and practices of dental students regarding HIV/AIDS infection and usage of rapid HIV testing kit in dental setups. On the basis of the results of this study, modifications can be done in dental curriculum at student level only to have better knowledge of HIV infections which can be prolific in curbing the menace of this deadly infection at an early stage only. This is an exploratory study conducted on a small scale, so it needs to be further expanded to get better understanding of the results. This is a small pilot study and it needs to be done on larger scale involving private dental practitioners also to have better insight regarding the early diagnosis of HIV infections by the dentists and feasibility of using routine HIV testing kit in dental setups. The time constraints and sample size might have affected the outcome of study to a lesser extent.

Source bias can be found here from the participants as some of them might have unknowingly answered just by guessing, which might be able to affect the results of the study.

Recommendations

By understanding the inadequate knowledge about testing and therapy for HIV in dental students, it becomes imperative for government regulatory bodies to stress on these topics in the current curriculum.[6]

Colleges and hospitals should conduct regular mandatory certificate courses to sensitize students toward PLWHs and their treatment.

An oral health-care personnel and dental student should try to spread awareness in the society regarding the social stigma toward HIV or AIDS, should educate the masses about its testing, and should also suggest them for the same at the nearest ICTC centers.


  Conclusion Top


As it is the moral and ethical responsibility of a dentist to impartially treat a patient without any discrimination based on the presence or absence of any infectious condition,[7] dental students must therefore be made aware of and should understand the importance of treating HIV/AIDS patients.[8]

From the present study, we found that although the overall knowledge of students about HIV/AIDS was adequate in terms of modes of transmission and prevention of transmission, there were inadequacies in terms of testing, treatment, and therapy. Though the knowledge was appropriate, students' attitude toward PLWHs was positive. The results indicate that the dental students are not well prepared to treat HIV/AIDS patients, but are sympathetic toward this group of patients.[9]

This can be achieved by proper modeling and making the students more sensitized toward PLWHAs apart from giving appropriate knowledge of the disease, regarding its ways of transmission, recognition of oral manifestations, and treatment and monitoring the condition.[10]

Acknowledgments

We would like to sincerely thank Dr. Dolly Patel, Dean, AMC Dental Hospital and College, for permitting us to conduct this survey.

We would also like to thank interns Shaily Kavi, Manisha Kriplani, and Hitesh Khatri for helping us in conducting the survey and also Neha Modi and Bhavini Pandit for their immense support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Oberoi SS, Sharma N, Mohanty V, Marya C, Rekhi A, Oberoi A, et al. Knowledge and attitude of faculty members working in dental institutions towards the dental treatment of patients with HIV/AIDS. Int Sch Res Notices 2014;2014:429692.  Back to cited text no. 1
    
2.
Prashant P, Sreenivasan V, Ankit G. India knowledge of HIV/AIDS and attitude of dental students towards HIV/AIDS patients: A cross-sectional survey. J Educ Ethics Dent 2011;1:59-63. Available from: http://www.jeed.in/article.asp?issn=0974-7761;year=2011;volume=1;issue=2;spage=59; epage=63;aulast=Patil. [Last accessed on 2017 Nov 25].   Back to cited text no. 2
    
3.
Prabhu A, Rao AP, Reddy V, Krishnakumar R, Thayumanavan S, Swathi SS, et al. HIV/AIDS knowledge and its implications on dentists. J Nat Sci Biol Med 2014;5:303-7.  Back to cited text no. 3
    
4.
Pollack HA, Pereyra M, Parish CL, Abel S, Messinger S, Singer R, et al. Dentists' willingness to provide expanded HIV screening in oral health care settings: Results from a nationally representative survey. Am J Public Health 2014;104:872-80.  Back to cited text no. 4
    
5.
Santella AJ, Conway DI, Watt RG. The potential role of dentists in HIV screening. Br Dent J 2016;220:229-33.  Back to cited text no. 5
    
6.
Ngaihte PC, Santella AJ, Ngaihte E, Watt RG, Raj SS, Vatsyayan V, et al. Knowledge of human immunodeficiency virus, attitudes, and willingness to conduct human immunodeficiency virus testing among Indian dentists. Indian J Dent Res 2016;27:4-11.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Reznik DA, Bednarsh H. Managing dental patients with HIV. J Multidiscip Care Decis Dent 2015. Available from: http://www. decisionsindentistry.com/article/managing-dental-patients-with-hiv/. [Last accessed on 2017 Nov 25].  Back to cited text no. 7
    
8.
Khan SA, Liew ML, Omar H. Role of ethical beliefs and attitudes of dental students in providing care for HIV/AIDS patients. Saudi Dent J 2017;29:7-14.  Back to cited text no. 8
    
9.
Dhanya RS, Hegde V, Anila S, Sam G, Khajuria RR, Singh R, et al. Knowledge, attitude, and practice towards HIV patients among dentists. J Int Soc Prev Community Dent 2017;7:148-53.  Back to cited text no. 9
    
10.
Singh VP, Osman IS, Rahmat NA, Bakar NAA, Razak NFNA, Nettem S, et al. Knowledge and attitude of dental students towards HIV/AIDS patients in Melaka, Malaysia. Malays J Med Sci 2017;24:73-82.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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