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

测试行为激活和解决问题相结合作为博茨瓦纳艾滋病毒吸烟者的新型戒烟行为干预措施

• 批准号: 10725267
• 负责人: ROBERT GROSS
• 金额: $ 14.65万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10725267
• 关键词: Address; Administrator; Affect; Africa; Africa South of the Sahara; Behavioral; Botswana; Cardiovascular Diseases; Caring; Chronic; Clinic; Clinical; Clinical Research; Community Health Aides; Community Workers; Consolidated Framework for Implementation Research; Country; Data; Decentralization; Developing Countries; Ensure; Epidemic; Goals; Guidelines; HIV; HIV Infections; HIV/TB; Health; Health Services; Health system; Healthcare; Healthcare Systems; Heterogeneity; High Prevalence; Income; Individual; Infrastructure; International; Intervention; Interview; K-Series Research Career Programs; Life; Lung diseases; Managed Care; Mentors; Methods; Modeling; Morbidity - disease rate; Outcome; Parents; Patients; Persons; Pharmacotherapy; Policies; Policy Maker; Population; Prevalence; Problem Solving; Protocols documentation; Provider; Recommendation; Research; Risk; Risk Factors; Sample Size; Sampling; Services; Smoker; Smoking; Smoking Cessation Intervention; Structure; System; Testing; Tobacco; Tobacco Use Cessation; Tobacco smoking behavior; Tobacco use; Treatment outcome; Tuberculosis; United States National Institutes of Health; Work; World Health Organization; antiretroviral therapy; cancer risk; care delivery; care systems; co-infection; cost; depressive symptoms; design; effectiveness evaluation; environmental tobacco smoke; follow-up; health care settings; health management; implementation framework; implementation science; infection risk; insight; intervention mapping; low and middle-income countries; mortality; novel; pandemic disease; programs; scale up; smoking cessation; smoking prevalence; system-level barriers; systematic review; tobacco cessation intervention; tobacco smokers; transmission process; treatment program; tuberculosis treatment

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.

项目摘要 吸烟是全世界发病率和死亡率最可预防的原因之一，并已 在非洲发展中国家成为一种日益严重的流行病。HIV+人群中服用抗逆转录病毒药物的人数 在治疗方面，吸烟比感染艾滋病毒造成的寿命损失更多。虽然行为方法和 在高收入国家，药物治疗通常一起使用，药物治疗在很大程度上是不可用的 在撒哈拉以南非洲地区，由于成本的原因。相反，开发和评估行为戒烟 可以实际传播的干预措施是解决个人烟草使用问题的优先事项。 博茨瓦纳等国的艾滋病毒携带者。然而，艾滋病毒的独特方面(例如，抑郁症状的高比率) 在以下情况下，必须考虑在这种环境(例如，分散的、有限的基础设施)中提供护理 在博茨瓦纳等低收入国家设计一种行为方法。 艾滋病毒携带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。 考虑到结核病护理的独特结构需要密切的医疗保健，可以考虑提供烟草护理 并有跟踪和内置社区卫生工作者等服务。吸烟与一种 感染风险增加，结核病转归更差。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 控制方案，戒烟服务尚未普遍纳入结核病或结核病/艾滋病毒控制 世界各地的戒烟方案，目前博茨瓦纳国家没有戒烟指南 结核病项目诊所。总体而言，关于实施和扩大戒烟的数据有限 结核病控制方案中的战略。 利用实施科学的原则和方法，这个项目将使用定性的方法来 确定针对HIV+患者实施戒烟干预措施的障碍和促进者 在博茨瓦纳的结核病治疗项目中，卫生服务通常与艾滋病毒诊所分开。它将增强 我们对实施戒烟服务的影响因素的认识是鲜明的、 LMIC中的重要环境和人口。这项工作将指导后续的临床研究的设计和 在这一背景下实施针对区域的烟草使用治疗。