Implementing Tobacco Use Treatment in HIV Clinics In Viet Nam

项目摘要 本附录建议进行一项纵向研究，将母公司目前的赠款投资组合扩大到 艾滋病毒携带者(PLWH)家庭粮食不安全的差异及其与 越南的粮食不安全和烟草使用。该副刊的重点是如何减少粮食不安全状况 对作为慢性病和传染病的PLWH经历的健康差距有重大影响 这项研究旨在评估戒烟对食物不安全的潜在影响。这个 研究的目的是：1)评估吸烟者家庭食物不安全程度的差异 2)审查吸烟与家庭之间的联系机制 PLWH在基线和6个月的随访中的粮食不安全状况，以及3)评估减少 在6个月的随访中，烟草使用和戒烟对粮食安全措施的影响。使用纵向的 设计与匹配的比较人口，我们将评估和比较粮食不安全的流行率在 HIV+吸烟者和非吸烟者的家庭水平及其相关机制探讨 与PLWH(吸烟者和不吸烟者)之间的粮食不安全问题；并评估吸烟的潜在影响 停止粮食不安全。我们假设，已经戒烟或减少吸烟的HIV+吸烟者 平均而言，每天吸烟50%以上的人比艾滋病毒+吸烟者的粮食不安全感要低 继续抽烟。这项研究的发现将有助于更好地理解如何筛查粮食不安全 可以在资源贫乏的情况下并入多管齐下的治疗计划中，从而识别食物 没有安全感的患者，这可能有助于减轻并存疾病的负面影响，并有助于 针对戒烟干预的政策和方案。这项补助金是建立在家长助学金的基础上的 它解决了越南公共卫生部门吸烟率高的问题。这笔赠款的长期目标是 开发一个可扩展的模式，用于在医疗保健环境中实施循证烟草使用治疗 治疗LMIC中的PLWH。赠款的目标是进行一项三组随机对照试验， 比较了三种实用的多水平、多成分烟草的效果和成本效益 门诊戒烟干预(OPC)。这三个臂是：1)3AS+R(标准护理)：ASK (筛查所有患者)，建议(建议戒烟)，协助(简短咨询)，并咨询越南国家 Quitline；2)SC+顾问：顾问=6次会议-针对PLWH量身定做的现场戒烟咨询干预 并由训练有素的现场诊所工作人员提供；以及3)SC+Counsel+N：N=4周的尼古丁替代 心理治疗。患者(n=672)将在越南的14个艾滋病毒门诊招募，并被随机分配到三个 学习手臂。这项研究将比较3AS+R(标准护理(SC)和Quitline转诊)和SC+2 烟草治疗模式的改进。家长津贴和补助金均使用一口井- 纽约大学和社会医学研究所建立了合作伙伴关系。

Project Summary This supplement proposes a longitudinal study that will extend the parent’s grant current portfolio to examine the difference in household food insecurity among people living with HIV (PLWH) and the relationship between food insecurity and tobacco use in Vietnam. The supplement focuses on how decreased food insecurity may have significant impact in the health disparities experienced on PLWH as chronic and infectious diseases intersect; and the study is powered to assess the potential impact of smoking cessation on food insecurity. The study aims are 1) to estimate the difference in household food insecurity among PLWH who smoke compared with PLWH who are non-smokers at baseline, and 2) to examine mechanisms linking smoking and household food insecurity among PLWH at baseline and 6-months follow-up, and 3) to assess the impact of a reduction in tobacco use and tobacco cessation on measures of food Insecurity at 6-month follow-up. Using a longitudinal design with a matched comparison population we will assess and compare the prevalence of food insecurity at the household level among individual HIV+ smokers and non-smokers and explore mechanisms associated with food insecurity among PLWH (smokers and non-smokers); and assess the potential impact of smoking cessation on food insecurity. We hypothesize that HIV+ smokers who have quit smoking or reduced cigarettes smoked per day by more than 50% will on average experience lower food insecurity than HIV+ smokers who continued to smoke. Findings from this study will help to better understand how screening for food insecurity may be incorporated in multipronged treatment programs in a resource poor setting, thereby identifying food insecure patients, which may help to alleviate the negative impact of co-occurring conditions and to inform policies and programs that address cessation interventions. The supplement builds on the parent grant which addresses the high prevalence of smoking in Viet Nam among PLWH. The long-term goal of the grant is to develop a scalable model for implementing evidence-based tobacco use treatment in health care settings treating PLWH in LMICs. The objective the grant is to conduct a 3-arm randomized controlled trial that compares the effectiveness and cost-effectiveness of three practical multilevel, multicomponent tobacco cessation interventions in outpatient clinics (OPC). The three arms are: 1) 3As+R (Standard Care): Ask (screen all patients), Advise (advice to quit), Assist (brief counseling), and Refer to Viet Nam’s national Quitline; 2) SC+Counsel: Counsel= 6-session onsite cessation counseling intervention tailored to PLWH and delivered by trained, onsite clinic staff; and 3) SC+Counsel+N: N= 4 weeks of nicotine replacement therapy. Patients (n=672) will be recruited at 14 HIV OPCs in Viet Nam and randomized into one of the three study arms. The study will compare the 3As+R (standard care (SC) with Quitline referral) to SC plus two tobacco treatment model enhancements. Both the parent grant and supplement makes use of a well- established partnership between NYU and the Institute for Social Medical Sciences.