Botswana Smoking Abstinence Reinforcement Trial (BSMART)

项目摘要 烟草使用在艾滋病毒/艾滋病感染者（PLWH）中非常普遍，特别是在南部非洲， 艾滋病毒感染最为集中。在艾滋病毒感染者中，烟草使用影响艾滋病毒相关的合并症， 非艾滋病毒相关恶性肿瘤（如肺癌）导致过早死亡的主要原因， 20%的癌症负担。整合循证干预，如筛查、短期干预和 将治疗转介到艾滋病毒护理系统（SBIRT）提供了一个重要的机会来建立和 在低收入和中等收入国家（LMIC）环境中评估可修改的癌症预防策略， 非专业卫生工作者（LHW）和非医师临床医生都被广泛使用。博茨瓦纳大学 马里兰州巴尔的摩（UMB）自2015年以来一直在工作，为公民监督广泛的艾滋病毒护理诊所网络。 撒哈拉以南非洲的人口健康调查显示， 12.5- 44.3%。然而，根据我们的试点数据，护理系统还没有做好迎接挑战的准备。 将循证戒烟治疗纳入常规艾滋病毒护理。博茨瓦纳政府 希望做更多的工作来帮助公民戒烟。为了迎接这一挑战，博茨瓦纳吸烟 禁欲强化试验（BSMART）建议使用2型混合有效性-实施研究 设计用于评价已确立的SBIRT干预措施的有效性和实施情况，包括 由经过培训的LHW个案经理提供5A（询问、建议、评估、协助、安排），然后转介 伐尼克兰（一种被证明对戒烟有效的药物， 艾滋病毒/艾滋病感染者1 -3和博茨瓦纳的处方集）， 博茨瓦纳的艾滋病门诊护理机构网络。RE-AIM框架指导的具体目标 （1）评估项目的覆盖面和有效性， BSMART; 2）评估通过和实施情况，以干预措施的质量和一致性为指标 交付; 3）评估干预措施是否作为常规实践的一部分得到维护; 4）确定 BSMART的初步成本效益。

PROJECT ABSTRACT Tobacco use is highly prevalent among people living with HIV/AIDS (PLWH) especially in southern Africa where HIV is most heavily concentrated. Among PLWH, tobacco use impacts HIV-related co-morbidities and is the leading cause of premature mortality from non-HIV related malignancies such as lung cancer which account for 20% of the cancer burden. Integrating an evidence-based intervention, such as Screening, Brief Intervention and Referral to Treatment (SBIRT) into a HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy into a low- and middle-income country (LMIC) setting where both lay health workers (LHW) and non-physician clinicians are widely used. Botswana, where the University of Maryland Baltimore (UMB) has worked since 2015, oversees a wide network of HIV care clinics for its citizens. Demographic Health Surveys from sub-Saharan Africa show that smoking prevalence among PLWH ranges 12.5-44.3%. Yet, based on our pilot data the system of care is highly unprepared to meet the challenge of integrating evidence-based smoking cessation treatment into routine HIV care. The Government of Botswana wants more to be done to assist its citizen in smoking cessation. To meet this challenge, the Botswana Smoking Abstinence Reinforcement Trial (BSMART) proposes to use a Type 2 hybrid effectiveness-implementation study design to evaluate the effectiveness and implementation of a well-established SBIRT intervention consisting of the 5As, (Ask, Advise, Assess, Assist, Arrange) delivered by trained LHW case managers, followed by referral to treatment with varenicline (a medication demonstrated to be efficacious for smoking cessation among PLWH1-3 and on formulary in Botswana) prescribed and monitored by trained nurse prescribers-dispensers, in the network of outpatient HIV care facilities in Botswana. The specific aims guided by the RE-AIM Framework and informed by an Implementation Governance Structure are to: 1) Assess Reach and Effectiveness of BSMART; 2) Assess the Adoption and Implementation indexed by quality and consistency of intervention delivery; 3) Assess whether the intervention becomes Maintained as part of routine practices; 4) Determine the preliminary cost-effectiveness of BSMART.