Evaluating smoking cessation interventions for PWH in South Africa: Efficacy, implementation, and cost-effectiveness.

项目摘要/摘要 该项目的目的是通过评估来优化南非威尔斯亲王医院的戒烟计划 循证戒烟干预的有效性、实施性和成本效益 在其他资源不足的环境中展示了成功。南非有750万艾滋病毒(PWH)患者， 占全球负担的近20%。南非也是每年结核病发病率最高的国家之一。 全球(520/100,000)，心血管疾病和慢性阻塞性肺病的负担越来越大 疾病(COPD)。吸烟是肺结核的危险因素，结核病是威斯康星医院死亡的主要原因。此外，威尔斯亲王医院现已 其他与吸烟有关的疾病的高风险，包括心血管疾病和肺部合并症 除结核病外。在南非，吸烟现象非常普遍；我们发现，52%的男性和13%的女性患有 艾滋病病毒是目前的吸烟者。南非政策支持吸烟筛查和戒烟努力 对于PWH；这些包括在南非国家抗逆转录病毒疗法(ART)指南中，南非 非洲STG-EML和南非临床实践指南。目前，在小学进行吸烟筛查 护理环境低，戒烟干预措施的提供更低。有效的战略支持 威尔斯亲王戒烟是必要的，以减轻与艾滋病毒和吸烟相关的负担 合并症。我们发现，社交和人际压力以及难以控制的渴望是 在南非吸烟的威尔斯亲王戒烟的障碍。为低资源环境制定的干预措施 经常解决这些近端的戒断预测和调解因素，并可以很容易地适应南非， 只要它们能产生有意义的戒烟率，并且实施起来可行。我们将评估四个 应对这些已确定挑战的循证戒烟干预措施：(1)强化戒烟 行为咨询，(2)同伴咨询，(3)联合尼古丁替代疗法，(4)varenicline。 干预发展由多阶段优化治疗策略(MOST)框架指导 在考虑时间和财政资源的情况下开发、优化和评估干预措施，如 以及实施的可行性和成本。在MOST的这个优化阶段，我们的首要目标是评估 这些干预措施在威斯康星医院中的主要作用和交互作用。第二个目标将表现为 使用REACH实施这些戒烟干预措施的实施决定因素， 有效性、采用、实施、维护(RE-AIM)框架，为扩大规模和 可持续发展。第三个目标是比较戒烟的成本、成本效益和预算影响。 作为常规计划实施的干预措施。结果将为戒烟的发展提供信息 为参与南非艾滋病毒计划的威斯康星医院优化的一揽子治疗方案。

PROJECT SUMMARY/ABSTRACT The purpose of this project is to optimize a smoking cessation program for PWH in South Africa by evaluating the efficacy, implementation, and cost-effectiveness of evidence-based smoking cessation interventions with demonstrated success in other low-resource settings. South Africa is home to 7.5 million people with HIV (PWH), nearly 20% of the global burden. South Africa also has one of the highest annual tuberculosis (TB) incidences globally (520/100,000) and an increasing burden of cardiovascular disease and chronic obstructive pulmonary disease (COPD). Smoking is a risk factor for TB, the leading cause of death among PWH. Further, PWH are at high risk for other smoking-related diseases, including cardiovascular disease and pulmonary comorbidities in addition to TB. In South Africa, tobacco smoking is prolific; we have found 52% of men and 13% of women with HIV to be current smokers. South African policy supports screening for smoking and smoking cessation efforts for PWH; these are included in the South African National antiretroviral therapy (ART) guidelines, the South African STG-EML, and the South African clinical practice guidelines. Currently, screening for smoking in primary care settings is low and delivery of smoking cessation interventions even lower. Effective strategies to support smoking cessation among PWH are necessary to reduce the burden of HIV- and smoking-associated comorbidities. We have found that social and interpersonal stressors and difficulty managing cravings are barriers to cessation among PWH who smoke in South Africa. Interventions developed for low-resourced settings often address these proximal predictors and mediators of cessation, and can be easily adapted for South Africa, provided they result in meaningful smoking abstinence rates and are feasible to implement. We will evaluate four evidence-based smoking cessation interventions that address these identified challenges: (1) intensive behavioral counseling, (2) peer counseling, (3) combination nicotine replacement therapy, and (4) varenicline. Intervention development is guided by the Multiphase Optimization Treatment Strategy (MOST), a framework for developing, optimizing, and evaluating interventions with consideration of time and financial resources, as well as feasibility of implementation and cost. During this optimization phase of MOST, our first aim will evaluate the main and interaction effects of these interventions among PWH. The second aim will characterize implementation determinants of delivery of these smoking cessation interventions using the Reach, Effectiveness, Adoptions, Implementation, Maintenance (RE-AIM) framework to inform scale-up and sustainability. The third aim will compare the costs, cost-effectiveness, and budget impact of smoking cessation interventions implemented as a routine program. Results will inform the development of a smoking cessation treatment package optimized for PWH engaged in the South African HIV program.