Oral Health Training Programs for Community and Professional Health Care Workers in Nairobi East District Increases Identification of HIV-Infected Patients

BackgroundBetter knowledge and skills for diagnosis and management of human immunodeficiency virus (HIV) related oral lesions by primary healthcare workers (PHWs) may increase recognition of HIV-related oral lesions (HROLs) and may improve implementation of HIV testing in Kenya. For this purpose training programs at health facility and community level were evaluated.Design and MethodsA pre-post control-test group design in two administrative divisions of Nairobi East District was used. Clinical competencies of PHWs (n = 32 intervention, and n = 27 control) at health facility level were assessed 9 months after training, and after 6 months for community health workers, (CHWs) (n = 411 intervention and n = 404 control) using written questionnaires, clinical data and patient interviews. Effects on referral for HIV testing and actual HIV testing were assessed by comparing laboratory registries pre- and post training.ResultsPHWs in intervention (n = 27; 84%) and control (n = 15; 60%) divisions, and CHWs in intervention (n = 330; 80%) and control (189; 47%) divisions, completed all questionnaires. Trained PHWs significantly increased their knowledge of HROLs (pConclusionTraining programs significantly increased PHW and CHW knowledge, recognition and management of HROLs but increased neither overall HIV testing rates nor overall percentage of positive tests. Speculation is that the health system and patient-related barriers seriously limit HIV testing.Trial RegistrationNetherlands Trial Register NTR2627 (date registered 22nd November 2010), and NTR2697 (date registered 13th January 2011).