Integrating tobacco use cessation into HIV Care and Treatment in Ministry of Health Facilities in Kisumu County, Kenya

将戒烟纳入肯尼亚基苏木县卫生部设施的艾滋病毒护理和治疗中

• 批准号: 10686945
• 负责人: STELLA AGUINAGA BIALOUS
• 金额: $ 71.91万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-16 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10686945
• 关键词: Abstinence; Acquired Immunodeficiency Syndrome; Address; Adoption; Adult; Africa; Africa South of the Sahara; African; Behavioral; Biochemical; Bupropion; California; Caring; Cessation of life; Clinic; Clinical; Communities; Community Health; Counseling; Country; County; Data; Diagnosis; Disease; Education; Enrollment; Epidemic; Evaluation; Family; General Population; Guidelines; HIV; HIV Infections; Health; Health Personnel; Health care facility; Heart Diseases; Intervention; Kenya; Malignant Neoplasms; Medical Research; Modeling; Morbidity - disease rate; Participant; Patient Self-Report; Patients; Persons; Pharmacotherapy; Policies; Population; Prevalence; Primary Care; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Institute; Risk; San Francisco; Services; Site; Smokeless; Smoking; Socioeconomic Status; Telemedicine; Telephone; Testing; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Universities; Woman; antiretroviral therapy; brief advice; brief intervention; clinical care; comorbidity; comparative cost effectiveness; compare effectiveness; coping; cost effective; cost effectiveness; evidence base; evidence based guidelines; experience; formative assessment; group intervention; high risk; improved; innovation; men; mortality; nicotine replacement; primary care setting; quitline; recruit; reduce tobacco use; response; scale up; social culture; symposium; tobacco cessation intervention; tobacco control; tobacco user

ABSTRACT People living with HIV (PLHIV) are more likely to use tobacco than the general population. PLHIV who use tobacco have higher mortality rates and risk for co-morbidities including diseases caused by tobacco, when compared to PLHIV who do not use tobacco. Sub-Saharan African continues to be the epicenter of HIV infection while experiencing an increase in tobacco consumption. There is evidence that PLHIV in Africa are more likely to use tobacco than the general population. Kenya is an example of a country coping with the dual epidemic of HIV and tobacco, with an estimated 1.5 million PLHIV and 2.5 million tobacco users. HIV remains one of the country's leading causes of morbidity and mortality, with an estimated 46,000 adults acquired HIV and 25,000 persons died of HIV in 2018. Tobacco use among the general population is estimated to be 11.6% (19.1% among men and 4.5% among women). The impact of tobacco use among PLHIV in Kenya has yet to be fully understood. There have been no research or initiatives in Kenya to support PLHIV to quit tobacco use in a primary care setting, a gap that this proposal seeks to address. In 2017, Kenya's Ministry of Health launched the National Guidelines for Tobacco Dependence Treatment and Cessation. This project will evaluate integration of the Guidelines' interventions into HIV care clinics through the Family AIDS Care & Education Services (FACES). FACES is a 16 years-partnership between the Kenya Medical Research Institute, the University of California San Francisco and the Kisumu County Ministry of Health. FACES have tested over 1.5 million people for HIV, diagnosing over 21,000 people, and currently serves over 51,000 PLHIV on ART in 61 sites in Kisumu County. We will conduct a cluster randomized controlled trial at 20 FACES- supported clinics, recruiting 580 patients to compare the effectiveness and cost-effectiveness of an intensive (Nicotine Replacement Therapy and Bupropion, 12 sessions of behavioral counseling through in-person and telemedicine approaches (telephone and texts), and provision of a quitline number) versus a brief (one-time counseling plus the quitline number) intervention. We hypothesize that 15% of intensive intervention group participants will achieve biochemically verified 7-day Point Prevalence Abstinence at 12 months compared to the brief intervention group quit rate of 5%. We will offer the intensive intervention to brief intervention group participants who continue to use tobacco at 12 months. Prior to the trial we will conduct a formative evaluation to tailor the Guidelines to PLHIV and after the trail we will assess assessing barriers to and facilitators of adoption, implementation, and factors associated with scalability/sustainability of the intervention. The proposed study will determine the most cost-effective strategy to integrate tobacco use cessation within HIV care in a community health setting. The project's results will inform policies to scale up tobacco dependence treatment within HIV primary care centers across the country and serve as a model for the region.

摘要 艾滋病毒携带者(PLHIV)比普通人群更有可能使用烟草。使用PLHIV的人 烟草有更高的死亡率和共病风险，包括由烟草引起的疾病，当 与不使用烟草的PLHIV相比。撒哈拉以南非洲地区仍然是艾滋病毒的中心 在经历烟草消费增加的同时感染。有证据表明，非洲的艾滋病病毒是 比一般人更有可能使用烟草。肯尼亚就是一个处理双重问题的国家。 艾滋病毒和烟草的流行，估计有150万艾滋病毒感染者和250万吸烟者。艾滋病毒残留物 这是该国发病率和死亡率的主要原因之一，估计有46000成年人感染了艾滋病毒 2018年有2.5万人死于艾滋病毒。一般人口的烟草使用率估计为11.6%。 (男性19.1%，女性4.5%)。肯尼亚艾滋病毒感染者中烟草使用的影响尚未 完全被理解。肯尼亚还没有支持艾滋病病毒戒烟的研究或倡议 在初级保健环境中，这项提案试图解决这一差距。2017年，肯尼亚卫生部 发布了《国家烟草依赖治疗和戒烟指南》。这个项目将 通过家庭艾滋病护理和评估将指南干预措施纳入艾滋病毒护理诊所的情况 教育服务(FACES)。Face是肯尼亚医学研究中心之间长达16年的合作伙伴关系 研究所、加州大学旧金山分校和基苏木县卫生部。面孔有 对150多万人进行了艾滋病毒检测，诊断了21,000多人，目前为51,000多人提供服务 在基苏木县的61个地点的艺术上。我们将对20个面孔进行整群随机对照试验- 支持临床，招募了580名患者，比较了强化治疗的效果和成本效益 (尼古丁替代疗法和安非他酮，通过面对面和 远程医疗方法(电话和短信)，提供免费电话号码)与简报(一次性) 咨询加上戒烟电话号码)干预。我们假设15%的强化干预组 参与者将在12个月内实现经过生物化学验证的7天点戒毒 短期干预组的戒烟率为5%。我们将对短期干预组进行强化干预 12个月后继续使用烟草的参与者。在审判之前，我们将进行形成性评估 为了量身定制针对PLHIV的指南，试验结束后，我们将评估、评估障碍和促进者 采用、实施以及与干预措施的可扩展性/可持续性相关的因素。这个 拟议的研究将确定将戒烟与艾滋病毒相结合的最具成本效益的战略 社区卫生环境中的护理。该项目的结果将为扩大烟草依赖的政策提供参考 在全国各地的艾滋病毒初级保健中心内进行治疗，并成为该地区的榜样。