Implementing Tobacco Use Treatment in HIV Clinics In Viet Nam

摘要 本申请是为了响应特别利益通知（NOSI）而提交的，该通知被确定为 NOT-CA-21-026。癌症污名是全球癌症控制和预防工作的一个关键障碍， 特别是在低收入和中等收入国家（LMIC）以及癌症高风险人群中 例如艾滋病毒/艾滋病感染者和吸烟者。癌症和癌症耻辱 对中低收入国家和艾滋病毒携带者的影响不成比例，需要采取干预措施，以减少癌症的耻辱感， 增加对生活在中低收入国家的艾滋病毒携带者的癌症预防和护理的参与;然而，几乎没有研究 研究了LMIC中PLWH中癌症耻辱的独特方面。在这项补充研究中， 将其纳入三臂戒烟实施效果随机对照试验 在越南的艾滋病毒携带者中，我们建议制定一个多成分的癌症耻辱量表， LMIC背景下的PLWH。首先，将进行定性调查以了解癌症是如何 污名--特别是肺癌污名--在两组PLWH中表现出差异， 癌症风险增加：吸烟的艾滋病毒携带者和不吸烟的艾滋病毒携带者。在这次调查中，三 癌症耻辱的理论化成分（即，公共的、内化的和制定的污名）和相关概念 如对癌症认识，艾滋病毒污名化和吸烟污名化等交叉污名化，以及突出的文化 将探讨各种考虑因素。这项定性工作和认知访谈的结果将为 选择项目以创建可在越南艾滋病毒携带者中使用的多成分癌症耻辱量表 南该量表草案将在越南PLWH样本中进行试点（N=100; n=50吸烟的PLWH 和n=50不吸烟的PLWH）。试点数据将用于进行心理评估的多， 癌症耻辱感量表，探讨癌症耻辱感，癌症 艾滋病毒和吸烟的耻辱感，以及各种相关的心理和行为因素，如有害的 心理症状（例如，抑郁症、焦虑症）、求医时机、艾滋病毒治疗依从性、 戒烟、癌症知识和自我效能。开发和验证多组分癌症 在越南的情况下，考虑到耻辱的文化突出表现， 更好地理解和解决癌症污名化问题以促进癌症控制的关键一步， 在不同的低收入、中等收入和低资源环境中开展预防工作。

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.