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

基本信息

批准号：
10269444
负责人：
STELLA AGUINAGA BIALOUS
金额：
$ 73.45万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
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/10269444
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 Disease Education Enrollment Epidemic Evaluation Family General Population Guidelines HIV HIV Infections HIV diagnosis Health Health Personnel Heart Diseases Intervention Kenya Malignant Neoplasms Medical Research Modeling Morbidity - disease rate Participant Patient Self-Report Patients Persons Pharmacotherapy Policies Population Prevalence Primary Health Care Randomized Controlled Trials Reporting Research Research Institute Risk San Francisco Services Site Smokeless Smoking Socioeconomic Status Telemedicine Telephone Testing Time Tobacco Tobacco Dependence Tobacco Use Cessation Tobacco use Universities Withholding Treatment Woman antiretroviral therapy base 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 implementation determinants 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

项目摘要

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.

抽象的与普通人群相比，艾滋病毒（PLHIV）患者（PLHIV）使用烟草的人更有可能使用烟草。使用的人烟草的死亡率较高和对包括烟草引起的疾病在内的合并症的风险，当与不使用烟草的PLHIV相比。撒哈拉以南非洲人继续成为艾滋病毒的中心在烟草消费量增加的同时感染。有证据表明非洲的PLHIV是比普通人群更有可能使用烟草。肯尼亚是一个国家应对双重的榜样艾滋病毒和烟草流行，估计有150万PLHIV和250万烟草使用者。艾滋病毒仍然存在该国发病和死亡率的主要原因之一，估计有46,000名成年人获得了艾滋病毒 2018年有25,000人死于艾滋病毒。烟草在普通人群中使用估计为11.6％（男性中19.1％，女性4.5％）。肯尼亚PLHIV中烟草使用的影响尚未完全理解。肯尼亚没有研究或计划支持PLHIV退出烟草的使用在初级保健环境中，该提案试图解决的差距。 2017年，肯尼亚卫生部制定了有关烟草依赖治疗和停止的国家指南。这个项目将通过家庭艾滋病护理和教育服务（面孔）。面孔是肯尼亚医学研究之间的16年伙伴关系研究所，加利福尼亚大学旧金山大学和基苏木县卫生部。面孔经过150万人的艾滋病毒测试，诊断为21,000多人，目前为51,000多人服务在Kisumu县61个地点的艺术品。我们将在20个面上进行簇随机对照试验 - 支持诊所，招募580名患者，以比较密集型的有效性和成本效益（尼古丁替代疗法和安非他酮，通过面对面的12次行为咨询会议远程医疗方法（电话和文本），并提供Quitline编号）与简短咨询加上Quitline编号）干预。我们假设密集干预组的15％参与者将在12个月时在12个月的生化验证的7天点戒酒中获得简短的干预组退出率为5％。我们将为简短干预小组提供密集的干预措施在12个月时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PLHIV的准则，在步道之后，我们将评估评估的障碍和促进者采用，实施以及与干预的可伸缩性/可持续性相关的因素。这拟议的研究将确定在HIV中整合烟草使用停止的最具成本效益的策略在社区健康环境中护理。该项目的结果将告知政策以扩大烟草依赖性全国艾滋病毒初级保健中心的治疗，并作为该地区的典范。