Testing the Combination of Behavioral Activation and Problem Solving as a Novel Behavioral Smoking Cessation Intervention for Smokers with HIV in Botswana

项目摘要 吸烟是全世界最可预防的发病和死亡原因之一， 在非洲的发展中国家日益流行。在接受抗逆转录病毒治疗的艾滋病毒阳性者中 在治疗中，吸烟比艾滋病毒感染造成更多的生命年损失。虽然行为方法和 在高收入国家，药物治疗通常同时使用， 在撒哈拉以南非洲，由于成本。相反，开发和评估行为戒烟 可以切实传播的干预措施是解决人们吸烟问题的优先事项 在博茨瓦纳等国家感染艾滋病毒。然而，艾滋病毒的独特方面（例如，抑郁症状发生率高） 以及在这样的环境中的护理递送（例如，分散的、有限的基础设施）， 在博茨瓦纳等中低收入国家设计行为方法。 艾滋病毒阳性者占博茨瓦纳结核病病例的60%，使结核病护理系统成为一个关键环境 考虑提供烟草护理，因为结核病护理的独特结构需要密切的医疗保健 后续行动，并有内置的服务，如社区卫生工作者。吸烟与一种 感染风险增加，结核病预后较差。烟草使用进一步对艾滋病毒的结果产生不利影响- 结核病合并感染者。虽然国际指南建议将戒烟纳入结核病 在结核病或结核病/艾滋病控制项目中，戒烟服务尚未普遍纳入 在世界各地的戒烟计划中，目前博茨瓦纳的国家戒烟指南中没有戒烟指南。 结核病规划诊所。总的来说，关于戒烟的实施和推广的数据有限 结核病控制计划中的战略。 利用实施科学的原则和方法，本项目将采用定性方法， 确定对艾滋病毒阳性者实施戒烟干预的障碍和促进因素 在博茨瓦纳的结核病治疗项目中，卫生服务通常与艾滋病诊所分开。它将加强 我们对影响推行戒烟服务的因素的理解， 重要环境和人口。这项工作将指导后续的临床研究的设计和 在这种情况下实施区域特定的烟草使用治疗。

Project Summary Tobacco smoking is one of the most preventable causes of morbidity and mortality worldwide and has become a growing epidemic in developing countries in Africa. Among HIV+ individuals on antiretroviral therapy, smoking causes more life-year loss than HIV infection. While both behavioral approaches and pharmacotherapy are typically used together in high-income countries, pharmacotherapy is largely unavailable in sub-Saharan Africa due to cost. Instead, developing and evaluating behavioral smoking cessation interventions, which could be realistically disseminated, is a priority for addressing tobacco use among persons with HIV in countries such as Botswana. Yet, unique aspects of HIV (e.g., high rate of depressive symptoms) and delivery of care in such settings (e.g., decentralized, limited infrastructure) must be considered when designing a behavioral approach in LMICs such as Botswana. HIV+ individuals constitute 60% of the cases of TB in Botswana, making the TB care system a critical setting to consider for tobacco care delivery given the unique structure of TB care that requires close healthcare follow-up and has built-in services such as community health workers. Tobacco smoking is associated with an increased risk of infection and poorer TB outcomes. Tobacco use further adversely impacts outcomes in HIV- TB co-infected individuals. While international guidelines recommend the inclusion of smoking cessation in TB control programs, smoking cessation services have not been universally included in TB or TB/HIV control programs around the world, and there are currently no smoking cessation guidelines in Botswana's National TB program clinics. In general, there is limited data on the implementation and scale-up of smoking cessation strategies within TB control programs. Using implementation science principles and methods, this project will use a qualitative approach to identifying the barriers and facilitators to implementing smoking cessation interventions for HIV+ individuals within the TB treatment programs in Botswana, a health service often separate from HIV clinics. It will enhance our understanding of factors affecting the implementation of smoking cessation services in a distinct and important setting and population in LMICs. This work will guide subsequent clinical research on the design and implementation of region-specific tobacco use treatments in this setting.