T A Muslim-University of KwaZulu-Natal.

Supervisor - Prof S Naidoo-University of Western

Cape

HIV infection is conducive to many oral lesions. PHC nurses are often the patients first point of contact, and can play a vital role in the early diagnosis; treatment and management. They are ideally positioned to identify HIVinfected persons through a simple visual assessment of the mouth, and to then refer these persons for VCT.

HIV infection presents a panorama of mucocutaneous manifestations,1 which may be the presenting feature of disease.2,3 Oral lesions may be predictive of disease progression,4 and in staging/classification. Timeous referral will lead to early medical intervention, with lower treatment costs and improved patient quality of life.

A study reported that 74.4% of HIV-infected patients presented with one or more oral mucosal lesions, of which only 30.4% were symptomatic.5 Another study found that 6% of the patients who first complained of oral symptoms were subsequently found to be diagnosed as HIV+.1

To improve PHC nurses identification, referral, treatment and knowledge of HIV/AIDS oral manifestations.

Ethical clearance, informed consent obtained. A cross-sectional survey of 267 nurses (total available nurses). A simple, convenience sample was utilised.

Pre- and post-education test,

Training and provision of educational material,

A quantitative and qualitative selfadministered questionnaire (demographics, training, experience, knowledge).

Data analyses using SAS statistical software. Linear model (frequency distribution and tables).

Pre-test and post-test included specific contrasts (differences) of interest between the two periods (pre vs. post).

RESULTS

Table 1: Pre- and PostTest Results correct responses only (n=121) No 01 02 03 04 05 06 07 08 09 10 Condition / Disease / Lesion Oral Candidiasis / Oral Thrush Angular Cheilitis Parotid Gland Enlargement Molluscum Contagiosum Oral Hairy Leukoplakia Herpes Simplex Periodontitis Kaposis Sarcoma Apthous Ulcers Dental Caries Mean correct responses/total respondents (n=121) MEAN (Percentage) Pre-test correct 87 (72%) 59 (48%) 54 (45%) 31 (26%) 50 (41%) 42 (35%) 14 (12%) 20 (17%) 46 (38%) 62 (51%) 46.5/121 Post-test correct 108 (89%) 95 (79%) 81 (67%) 81 (67%) 82 (68%) 67 (55%) 43 (36%) 48 (40%) 71 (59%) 77 (64%) 75.3/121 Percentage difference 17% 31% 23% 41% 27% 20% 24% 23% 21% 13%

(38,5%)

(62,4%)

24%

100

90
80

21 36
% increase on PreTest Results following education.

70
60

27 50

32 25 28 25

15

50
40

30
20

29

Pre-Test Results

10

72
0

48

45

26

41

35

12

17

38

51

Condition 1 Condition 2 Condition 3 Condition 4 Condition 5 Condition 6 Condition 7 Condition 8 Condition 9 Condition 10

120%

100%

30% 80%

60%

80% 90%

77%

No Yes

40%

20%

0% Training in VCT Training included diagnosis and Training in HIV/AIDS management Training included diagnosis and management of oral conditions management of oral conditions

Number of Reason Nurses

Percentage

Not trained in assessment of oral cavity

17

20.7%

Not the task of the nurse, but of the Dental Practitioner

18

21.9%

Only presenting signs and symptoms are assessed and treated

43

52.4%

Exam of mouth is not part of the routine screening process

5%

Other reasons

TOTAL

82

100%

A large number did not receive substantial OH education during pre-and postqualification education. Inadequate knowledge of OH assessment and the common prognostic oral manifestations. 67.8% reported that they do not examine the mouth as part of routine overall assessment of the patient, Only 13% referred patients for VCT.

Basic OH education produced statistically significant improvements in knowledge/referral patterns, and should be extended to all nurses. Need to include OH assessment and OH promotion into undergraduate and postgraduate nursing curricula. Need for continuous professional development (CPD).

1.

Arendorf TM, Bredenkamp B, Cloete CA et al. (1998). Oral manifestations of HIV infection in 600 South African patients. Journal of Oral Pathology and Medicine 27: 176-179. Ferreira S, Noce C, Silva Jnr A, Goncalves L, Torres S, Meeks V, Luiz R and E Dias. (2007). Prevalence of oral manifestations of HIV infection in Rio De Janerio, Brazil from 1988 to 2004. AIDS Patient Care and STDs, 2007:21;10,724-731. Fauci AS and H Clifford-Lane. Human Immunodeficiency Virus (HIV) disease: AIDS and related disorders. In: Braunwald E, Hauser SL, Fauci AS, Long DL, Kasper DL, Jameson JL, editors. Harrisons Principles of Internal Medicine. 15th ed. New York: McGraw- Hill; 2001. 2. 1852-912.

2.

3.

4. Chidzonga MM (2003) HIV/AIDS orofacial lesions in 156 Zimbabwean patients at referral oral and maxillofacial surgical clinics. Oral Diseases, 2003:9:317-322.
5. Moon H-S, Jung JY, Horowitz AM and DI Paik. Korean Dental hygienists knowledge and their opinions about aetiology and prevention of dental caries. Community Dentistry and Oral Epidemiology Oct 1998; 26 (5): 296-302.

6.

Johnson NW, M Glick and TNL Mbuguye. Oral health and general health. Advances in Dental Research, April 1, 2006; 19(1): 118 121.

Sincere thanks:
Prof

S Naidoo PHC nurses of DC22

Thank you!