Our study is one of the first to determine the prevalence, correlates and treatment needs of dental caries among PWH in Uganda. Our findings highlight the high prevalence of DMFT among the study population at 67%, (130/194), 95% CI (60–75%) with the decayed component among those with dental caries experience being very high (113/130, 86.9%) and an association between lower CD4 and dental caries. The results also reveal a gap in prevention needs of over 90% among the participants as these had never had a dental checkup despite having dental caries. The gap between the decayed teeth (DT) 113 and filled teeth (FT) (8) is a clear demonstration of possible inadequacies in knowledge, availability or access to dental services that require further investigations. Most of the variables including socio-demographic characteristics, gender, life style, and ART duration were not associated with dental caries. The observation above might be resulting from the relatively small sample size of only 194 participants or this being a cross sectional study.
In this study majority of the participants were females (63.9%) and young with 60.8% aged 45 years and below. Majority had primary or no formal education. In many aspects, our findings are similar to what was found in an urban population in Uganda on ART  in which the majority of participants (65.6%) were female and were young with mean age of 39 years. In another study on women living with HIV and on ART carried out in Eastern Uganda, those who had dental caries, were also young with mean age of 35 years . The findings of more women participants in our study can be explained by the fact that in this setting, women tend to seek care more than men. This is reflected in other sub-Saharan African countries where women with HIV tend to enroll more in ART than the men living with HIV. Worse still men tend to report at stage IV of HIV [18–20].
Two thirds of our study participants (67%) had dental caries (DMFT > 0). There was a higher overall prevalence of dental caries in women (n = 85, 65.4%) compared to men (n = 45, 34.6%). This is similar to those found by Kalanzi et al (2019) who found a high overall prevalence of 83.7% and a higher prevalence among females 86.6% than males 78.2%. Birungi and others (2021) also found a high prevalence of dental caries (81% ) in a rural population of HIV positive women . The reasons as to why women in this study population have a higher prevalence of dental caries than men are not clear but may be due to differences in snacking, oral hygiene and dietary habits thus a need for further research in this area. The high prevalence of dental caries in our study is a reflection of the general population probably due to lack of preventive and curatives oral services.
Surprisingly, we found a statistically significant (P = 0.034) higher prevalence (n = 96, 73.8%) of dental caries among those with a higher CD4 count (> 350 cells/µL) compared to those with a lower CD4 count (N = 34, 26.2%). This is an area that requires further exploration to investigate the conflicting role of ART in dental caries.
Our findings reveal a large prevention need as demonstrated by a high proportion of participants who have never gone for a checkup (n = 176, 90.7%) and of these 90.8% had caries. Furthermore, we found a high overall oral treatment need of 96% as the number of patients with decayed and /or missing teeth had never had them filled or replaced. Additionally, 13.9% never brushed their teeth at all this call for need for oral health education intervention. Among participants with dental caries (DMFT < 0) 113 had decayed teeth which were not filled and 79 had missing teeth which were not replaced. This further raises a need for a large scale survey among people on ART to generate stronger evidence for integrating dental and oral health into HIV care. Besides the evidence from a low filled (8) component of DMFT index despite a high decay (113) component is strong indication for lack of individual dental care for the patient as decaying teeth are ignored. To mitigate this glaring disparity, there is need to include dental and oral health care services in the national guidelines for HIV care.
The limitations of our study include the fact that this work was conducted in a high volume clinic in a single regional referral hospital. It would be interesting to conduct a similar study at primary health care facility using a larger population and also to include a non HIV comparison group.