Attitudes, Barriers, and Facilitators towards the Integration of HIV Testing into Dental Treatment among Dental Practitioners in Central Uganda: A mixed-methods study

Abstract Background: Uganda has made significant progress in the fight against HIV, but the first UNAIDS "95-95-95" target, with 95% of HIV-positive individuals aware of their status,remains unmet. Dental care has high potential to enhance HIV diagnosis; however, it has not been well leveraged for integrated HIV testing services. Objective: To assess the attitudes, barriers, and facilitators towards the integration of HIV Testing into dental care among dental Practitioners in Uganda. Method: A mixed-methods explanatory study was conducted at high-volume dental care facilities in Kampala, including Mengo, Lubaga, and Mulago National Referral Hospitals and the Jubilee Dental Clinic. Consecutive sampling was used to recruit 97 dental healthcare service providers for the structured quantitative interviews. Qualitative data were collected through in-depth interviews with key informants. Quantitative data were analyzed using frequency distributions, cross-tabulation, analysis of variance (ANOVA), and principal component analysis using SPSS version 26. Qualitative data were analyzed using inductive thematic analysis. Results: Participants had a mean age of 31.2 years (standard deviation [SD] = 8.1), and the majority were general dentists (43, 44.3%). Only 7% of dental care providers had a positive attitude, although 91% expressed a willingness to integrate HIV testing into dental care. There were no statistically significant differences in attitudes across dental care practitioner characteristics (P >0.05). Principal component analysis identified four barriers and four facilitators to HIV testing integration. Upon ranking, the two most important barriers were time constraints (83.5%) and the fear of negative patient reactions (79.4%). The leading facilitators were adequate training and support for dental practitioners (93.8%) and access to free or low-cost HIV testing kits and supplies (89.7%). Qualitative findings reinforced these results, with participants emphasizing workflow delays and anticipating patient resistance as key barriers. Provider training and supportive policy mandates were viewed as important enablers of integration. Conclusion: Dental care practitioners have low positive attitudes despite a high willingness to integrate HIV testing into dental care, suggesting an ambivalence between motivation and practice. Key barriers included time constraints and anticipated negative patient reactions, while adequate training, provider support, and access to affordable HIV testing kits emerged as important facilitators.