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

摘要 艾滋病毒感染者（PLHIV）比普通人群更有可能使用烟草。艾滋病毒感染者 烟草具有较高的死亡率和合并症风险，包括烟草引起的疾病， 与不吸烟的艾滋病毒感染者相比。撒哈拉以南非洲仍然是艾滋病毒的中心 感染，同时经历烟草消费的增加。有证据表明，非洲的艾滋病毒感染者 比一般人更容易吸烟。肯尼亚是一个应对双重危机的国家， 艾滋病毒和烟草的流行，估计有150万艾滋病毒感染者和250万烟草使用者。艾滋病毒仍然是 这是该国发病率和死亡率的主要原因之一，估计有46，000名成年人感染了艾滋病毒 2018年有25，000人死于艾滋病毒。据估计，普通人群中的烟草使用率为11.6%。 (19.1男性占4.5%，女性占4.5%）。烟草使用对肯尼亚艾滋病毒感染者的影响还有待进一步研究。 被完全理解。肯尼亚没有研究或倡议支持艾滋病毒感染者戒烟 在初级保健环境中，这一建议试图解决的差距。2017年，肯尼亚卫生部 推出了国家烟草依赖治疗和戒烟指南。该项目将 评估通过家庭艾滋病护理将《准则》的干预措施纳入艾滋病毒护理诊所的情况， 教育服务（FACES）。FACES是肯尼亚医学研究中心与 研究所、加州旧金山弗朗西斯科和基苏穆县卫生部。面具有 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多名艾滋病毒感染者提供服务 在基苏穆县的61个地点进行抗逆转录病毒治疗。我们将在20个面部进行一项随机分组对照试验- 支持诊所，招募580名患者，比较强化治疗的有效性和成本效益。 （尼古丁替代疗法和安非他酮，12次行为咨询， 远程医疗方法（电话和短信），并提供戒烟热线号码）与简报（一次性 咨询加戒烟热线号码）干预。我们假设15%的强化干预组 参与者将在12个月时达到生化验证的7天点流行率禁欲， 短期干预组戒烟率为5%。我们将为简短的干预组提供强化干预 在12个月内继续使用烟草的参与者。在试验之前，我们将进行形成性评估 为艾滋病毒感染者量身定制指南，在试验之后，我们将评估评估艾滋病毒感染者的障碍和促进因素。 采用、实施以及与干预的可扩展性/可持续性相关的因素。的 拟议的研究将确定最具成本效益的战略，将戒烟纳入艾滋病毒 在社区健康环境中进行护理。该项目的结果将为扩大烟草依赖的政策提供信息 在全国各地的艾滋病毒初级保健中心进行治疗，并成为该地区的典范。

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.