Honghu Liu

Background: A pillar in the effort to end the HIV epidemic, the “Undetectable equals Untransmittable” (U = U) campaign has led to reduced HIV stigma and empowered people living with HIV (PLWH). Viral suppression, which eliminates risk of sexual HIV transmission, highlights the crucial role of adherence to antiretroviral therapy (ART). Strategies to enhance adherence have primarily focused on pill-taking reminders, often without real-time monitoring or interventions to address social and behavioral determinants of health (SBDOH). Suboptimal adherence to antiretroviral therapy often requires interventions from multidisciplinary teams, including nurses, social workers, and case managers to address SBDOH. These interventions often only occur weeks to months after adherence problems are identified, leading to delays in addressing patient needs and adherence to ART. Methods: In this protocol paper, we describe the design and procedures for a National Institutes of Health-funded randomized controlled trial that tests an innovative, integrated intervention combining the latest pill ingestible sensor system (the ID-Cap from etectRx) and strategies to address SBDOH. The intervention will trigger real-time actions to rapidly address SBDOH-related barriers when pre-specified patterns of poor adherence are detected (antiretroviral doses missed on three days within a five-day period). A cohort of 110 PLWH who have, or are at high risk for, sub-optimal adherence will be recruited from an HIV clinic in Los Angeles County. Participants will be randomized into the ingestible sensor intervention arm or the usual care arm. The intervention will run for 16 weeks, followed by a 12-week post-intervention period to evaluate sustainability. The primary outcomes are acceptability of the integrated intervention, frequency and timeliness of SBDOH intervention, level of challenges of SBDOH in HIV treatment, adherence to ART measured by ID-Cap system, and self-reported medication adherence. Secondary outcomes are plasma HIV viral load and high risk sexual activity, Discussion: Real-time monitoring of adherence will enable multidisciplinary teams to promptly address difficulties of SBDOH with tailored content to fit each individual’s unique challenges and needs. When completed, this trial will define the potential role of ingestible sensor system in a comprehensive program to address barriers to adherence and improve control of the HIV epidemic. Trial registration number: NCT06480578. Date registration: June 28, 2024.

Objectives: Surveys can assist in screening oral diseases in populations to enhance the early detection of disease and intervention strategies for children in need. This paper aims to develop short forms of child-report and proxy-report survey screening instruments for active dental caries and urgent treatment needs in school-age children.Methods: This cross-sectional study recruited 497 distinct dyads of children aged 8–17 and their parents between 2015 to 2019 from 14 dental clinics and private practices in Los Angeles County. We evaluated responses to 88 child-reported and 64 proxy-reported oral health questions to select and calibrate short forms using Item Response Theory. Seven classical Machine Learning algorithms were employed to predict children’s active caries and urgent treatment needs using the short forms together with family demographic variables. The candidate algorithms include CatBoost, Logistic Regression, K-Nearest Neighbors (KNN), Naïve Bayes, Neural Network, Random Forest, and Support Vector Machine. Predictive performance was assessed using repeated 5-fold nested cross-validations.Results: We developed and calibrated four ten-item short forms. Naïve Bayes outperformed other algorithms with the highest median of cross-validated area under the ROC curve. The means of best testing sensitivities and specificities using both child-reported and proxy-reported responses were 0.84 and 0.30 for active caries, and 0.81 and 0.31 for urgent treatment needs respectively. Models incorporating both response types showed a slightly higher predictive accuracy than those relying on either child-reported or proxy-reported responses.Conclusions: The combination of Item Response Theory and Machine Learning algorithms yielded potentially useful screening instruments for both active caries and urgent treatment needs of children. The survey screening approach is relatively cost-effective and convenient when dealing with oral health assessment in large populations. Future studies are needed to further leverage the customize and refine the instruments based on the estimated item characteristics for specific subgroups of the populations to enhance predictive accuracy.

Background: This scoping review reports on studies that collect survey data using quantitative research to measure self-reported oral health status outcome measures. The objective of this review is to categorize measures used to evaluate self-reported oral health status and oral health quality of life used in surveys of general populations. Methods: The review is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) with the search on four online bibliographic databases. The criteria include (1) peer-reviewed articles, (2) papers published between 2011 and 2021, (3) only studies using quantitative methods, and (4) containing outcome measures of self-assessed oral health status, and/or oral health-related quality of life. All survey data collection methods are assessed and papers whose methods employ newer technological approaches are also identified. Results: Of the 2981 unduplicated papers, 239 meet the eligibility criteria. Half of the papers use impact scores such as the OHIP-14; 10% use functional measures, such as the GOHAI, and 26% use two or more measures while 8% use rating scales of oral health status. The review identifies four data collection methods: in-person, mail-in, Internet-based, and telephone surveys. Most (86%) employ in-person surveys, and 39% are conducted in Asia-Pacific and Middle East countries with 8% in North America. Sixty-six percent of the studies recruit participants directly from clinics and schools, where the surveys were carried out. The top three sampling methods are convenience sampling (52%), simple random sampling (12%), and stratified sampling (12%). Among the four data collection methods, in-person surveys have the highest response rate (91%), while the lowest response rate occurs in Internet-based surveys (37%). Telephone surveys are used to cover a wider population compared to other data collection methods. There are two noteworthy approaches: 1) sample selection where researchers employ different platforms to access subjects, and 2) mode of interaction with subjects, with the use of computers to collect self-reported data. Conclusion: The study provides an assessment of oral health outcome measures, including subject-reported oral health status and notes newly emerging computer technological approaches recently used in surveys conducted on general populations. These newer applications, though rarely used, hold promise for both researchers and the various populations that use or need oral health care.

This study reports the results of focus groups with school nurses and teachers from elementary, middle, and high schools to explore their perceptions of child and adolescent oral health. Participants included 14 school nurses and 15 teachers (83% female; 31% Hispanic; 21% White; 21% Asian; 14% African American; and 13% Others). Respondents were recruited from Los Angeles County schools and scheduled by school level for six one-hour focus groups using Zoom. Audio recordings were transcribed, reviewed, and saved with anonymization of speaker identities. NVivo software (QSR International, Melbourne, Australia) was used to facilitate content analysis and identify key themes. The nurses’ rate of “Oral Health Education” comments statistically exceeded that of teachers, while teachers had higher rates for “Parental Involvement” and “Mutual Perception” comments. “Need for Care” was perceived to be more prevalent in immigrants to the United States based on student behaviors and complaints. “Access to Care” was seen as primarily the nurses’ responsibilities. Strong relationships between community clinics and schools were viewed by some as integral to students achieving good oral health. The results suggest dimensions and questions important to item development for oral health surveys of children and parents to address screening, management, program assessment, and policy planning.

This study reports results of focus groups with school nurses and teachers from elementary, middle, and high schools to explore their perceptions of child and adolescent oral health. Participants included 14 school nurses and 15 teachers (83% Female; 31% Hispanic, 21% White, 21% Asian, 14% African American, and 13% Others). Respondents were recruited from Los Angeles County schools and scheduled by school level for six one-hour focus groups, using Zoom. Audio recordings were transcribed, reviewed, and saved with anonymization of speaker identities. NVivo software was used to facilitate content analysis and identify key themes. The nurses’ rate of “Oral Health Education” comments statistically exceeded that of teachers, while teachers had higher rates for “Parental Involvement” and “Mutual Perception” “Need for Care” was perceived to be more prevalent in immigrants to the United States based on student behaviors and complaints. “Access to Care” was seen as primarily the nurse’s role. Strong relationships between community clinics and schools were viewed by some as integral to students achieving good oral health. The results suggest dimensions and questions important to item development for oral health surveys of children and parents to address screening, management, program assessment, and policy planning.

Background The era of modern information technology enables multiple methods and modes of collecting self-reported oral health information. The scope of the use of these various modalities has not been well classified or summarized, therefore it is necessary to study the degree to which various technologies were used to collect oral health outcomes and related data. This paper reports on a scoping review of the range of data collection methods in quantitative research to measure self-reported oral health status. All methods of data collection were assessed; papers whose methodologies employed newer technologies were identified. Method The review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) with the search on four online bibliographic databases. We analyzed peer-reviewed articles and reviews published between 2011 and September 2021 to determine data collection methods. Eligible publications were required to use quantitative methods that have a principal objective of measuring self-assessed oral health status, and/or oral health-related quality of life. Result We examined the past decade-long trends and found that there has been an increased interest in assessing self-reported oral health and oral health related quality of life data, a dominance of impact measures used, and the application of technologies to the methods. We found that 50 percent of all papers focused mainly on an impact measure. Technologies used included: computer-generated sample populations through polling techniques and crowd-sourcing software; together with tablets and computers to assist in data collection. Conclusion The study provides an overview of methods and modes to collect self-reported oral health data, especially with emerging technologies. Contemporary web-based approaches offer enhanced opportunities for survey research to boost recruitment, participation of study subjects with wide and diverse backgrounds from almost unlimited geographic areas, and efforts to improve quality by assuring increased response rates and reducing bias, especially in longitudinal studies. Several studies with strong standard methods of conducting oral health studies that have been successfully collecting these data for years were often not likely to adopt newer technologies because computer access is not available to their populations.

Background: Dental caries is the most common chronic childhood infectious disease and is a serious public health problem affecting both developing and industrialized countries, yet it is preventable in most cases. This study evaluated the potential of screening for dental caries among children using a machine learning algorithm applied to parent perceptions of their child’s oral health assessed by survey. Methods: The sample consisted of 182 parents/caregivers and their children 2–7 years of age living in Los Angeles County. Random forest (a machine learning algorithm) was used to identify survey items that were predictors of active caries and caries experience. We applied a three-fold cross-validation method. A threshold was determined by maximizing the sum of sensitivity and specificity conditional on the sensitivity of at least 70%. The importance of survey items to classifying active caries and caries experience was measured using mean decreased Gini (MDG) and mean decreased accuracy (MDA) coefficients. Results: Survey items that were strong predictors of active caries included parent’s age (MDG = 0.84; MDA = 1.97), unmet needs (MDG = 0.71; MDA = 2.06) and the child being African American (MDG = 0.38; MDA = 1.92). Survey items that were strong predictors of caries experience included parent’s age (MDG = 2.97; MDA = 4.74), child had an oral health problem in the past 12 months (MDG = 2.20; MDA = 4.04) and child had a tooth that hurt (MDG = 1.65; MDA = 3.84). Conclusion: Our findings demonstrate the potential of screening for active caries and caries experience among children using surveys answered by their parents.