Implementing Tobacco Use Treatment in HIV Clinics In Viet Nam

摘要 本申请是对特别利益通知(NOSI)的回应，该通知被确认为 不是CA-21-026。癌症污名是全球癌症控制和预防努力的关键障碍，但 特别是在中低收入国家(LMIC)和癌症高危人群中 例如艾滋病毒/艾滋病患者和吸烟者。癌症和癌症污名 对LMIC和PLWH患者的不成比例影响需要干预，以减少癌症耻辱和 更多地参与癌症预防和对生活在LMIC中的PLWH的护理；然而，很少或根本没有研究 调查了LMIC中PLWH中癌症污名的独特方面。在这项补充研究中， 纳入一项三臂戒烟实施效果随机对照试验 在越南的PLWH中，我们建议开发一种多成分癌症污名量表，用于 LMIC上下文中的PLWH。首先，将进行定性调查，以了解癌症是如何 耻辱--尤其是肺癌耻辱--在两组PLWH中的不同表现 癌症风险增加：吸烟的PLWH和不吸烟的PLWH。在这次调查中，有三个人 癌症污名的理论化组成部分(即公共污名、内在化污名和制定的污名)和相关概念 如癌症意识、交叉污名，如艾滋病毒污名和吸烟污名，以及突出文化 我们将探讨这些考虑因素。这项定性工作和认知访谈的结果将向 选择项目以创建可在越南PLWH中使用的多成分癌症污名量表 南。该量表草案将在越南长寿吸烟者(N=100；n=50)中试行 和n=50不吸烟的PLWH)。飞行员的数据将被用来对多人进行心理测量评估 组成癌症污名量表，探讨癌症污名与癌症的相关性和关联性 意识、艾滋病毒和吸烟污名，以及各种相关的心理社会和行为因素，如有害的 心理症状(如抑郁、焦虑)、就医时机、艾滋病毒治疗依从性 戒烟、癌症知识和自我效能。一种多组分癌症的研制和验证 在越南背景下的耻辱度，在某种程度上解释了耻辱感在文化上的突出表现是 朝着更好地理解和解决癌症污名迈出的关键一步，以促进癌症控制和 跨不同的LMIC和低资源环境进行预防。

ABSTRACT This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-21-026. Cancer stigma presents a key barrier to cancer control and prevention efforts globally, but especially in low- and middle-income countries (LMICs) and among populations who are at high risk for cancer such as people living with HIV/AIDS (PLWH) and those who smoke. Cancer and cancer stigma’s disproportionate impact on people in LMICs and PLWH warrants intervention to reduce cancer stigma and increase engagement in cancer prevention and care for PLWH living in LMICs; however, little to no research has investigated the unique aspects of cancer stigma among PLWH in an LMIC. In this supplemental study, which is integrated into a three-arm tobacco cessation implementation-effectiveness randomized control trial among PLWH in Viet Nam, we propose to develop a multi-component cancer stigma scale for use among PLWH in an LMIC context. First, a qualitative investigation will be conducted to understand how cancer stigma—and specifically lung cancer stigma—manifests among two groups of PLWH at differentially augmented risks of cancer: PLWH who smoke and PLWH who do not smoke. In this investigation, three theorized components of cancer stigma (i.e., public, internalized, and enacted stigma) and related concepts such as cancer awareness, intersecting stigmas such as HIV stigma and smoking stigma, and salient cultural considerations will be explored. Findings from this qualitative work and cognitive interviewing will inform the selection of items to create a multi-component cancer stigma scale that can be used among PLWH in Viet Nam. The draft scale will be piloted among a sample of Vietnamese PLWH (N=100; n=50 PLWH who smoke and n=50 PLWH who do not smoke). Pilot data will be used to conduct psychometric evaluation of the multi- component cancer stigma scale and explore correlations and associations between cancer stigma, cancer awareness, HIV and smoking stigma, and various related psychosocial and behavioral factors such as harmful psychological symptoms (e.g., depression, anxiety), timing of health-seeking, HIV treatment adherence, smoking cessation, cancer knowledge, and self-efficacy. Developing and validating a multi-component cancer stigma scale in the context of Viet Nam in a way that accounts for culturally salient expressions of stigma is a crucial step towards better understanding and addressing cancer stigma to promote cancer control and prevention across diverse LMIC and low-resource settings.