title: A Community-based Oral Health Promotion Model for HIV Patients in Nairobi, East District in Kenya: a Study Protocol.
abstract: BACKGROUND
  General HIV-related orofacial lesions, most commonly oropharyngeal candidiasis, have a typical clinical appearance and can be recognised by members of the community. Although affected patients often experience pain leading to compromised eating and swallowing, barriers such as social stigma and lack of knowledge regarding available services may prevent them from seeking early care. Educating the community about these lesions through community health workers (CHWs) who are democratically elected community members may encourage individuals affected to seek early oral healthcare in the health facilities. A health facility (HF) is a health centre mainly run by clinical officers (CO), i.e. personnel with a 3-year medical training, and nurses. This study aims to evaluate the effect of a CHW training programme on: i) their knowledge and recognition of HIV-related oral-facial lesions at a community level; and ii) referral of affected patients from the community to the HFs.
  
  
  METHODS
  All 800 CHWs in 2 administrative divisions of Nairobi East District (test group n=400; control group n=400) will be selected. The test group will receive training. CHWs in both groups will be assessed at 4 time points: -3, 0, +3 and +6 months with reference to the training on: i) their knowledge of HIV-related orofacial lesions (using a written questionnaire); and ii) their performance in referring affected patients to the HFs (using clinical data).
  Early recognition of HIV-related orofacial lesions at a community level will prompt community members to seek early oral care, leading to early HIV testing and counselling regarding failure of antiretroviral therapy, while treatment outcomes are still favourable.
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Nairobi Dental Teaching Hospital , Kenya.
authors.forename: Lucina N
authors.initials: LN
authors.lastname: Koyio
authors.affiliation: Department of Global Oral Health, Radboud University Nijmegen Medical Centre, College of Oral Sciences , Nijmegen, The Netherlands.
authors.forename: Wil J M
authors.initials: WJ
authors.lastname: van der Sanden
authors.affiliation: Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen Institute for Infection , Inflammation and Immunity, The Netherlands.
authors.forename: Andre
authors.initials: A
authors.lastname: van der Ven
authors.affiliation: Department of Global Oral Health, Radboud University Nijmegen Medical Centre, College of Oral Sciences , Nijmegen, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Mulder
authors.affiliation: Department of Oral Rehabilitation, Radboud University Nijmegen Medical Centre, College of Oral Sciences , Nijmegen, The Netherlands.
authors.forename: Nico H J
authors.initials: NH
authors.lastname: Creugers
authors.affiliation: Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre , Nijmegen, The Netherlands.
authors.forename: Matthias A W
authors.initials: MA
authors.lastname: Merkx
authors.affiliation: Department of Global Oral Health, Radboud University Nijmegen Medical Centre, College of Oral Sciences , Nijmegen, The Netherlands.
authors.forename: Jo E
authors.initials: JE
authors.lastname: Frencken
keywords: HIV; community; oral health.