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

项目总结/摘要 本项目的目的是通过评估， 循证戒烟干预的有效性、实施和成本效益， 在其他低资源环境中取得了成功。南非有750万艾滋病毒感染者， 占全球总负担的近20%。南非也是结核病年发病率最高的国家之一 在全球范围内（520/100，000），心血管疾病和慢性阻塞性肺疾病的负担日益加重 疾病（COPD）。吸烟是结核病的危险因素，而结核病是导致威尔斯亲王医院病人死亡的主要原因。此外，威尔斯亲王医院在 其他吸烟相关疾病的风险较高，包括心血管疾病和肺部合并症， 除了TB。在南非，吸烟是多产的;我们发现，52%的男性和13%的女性， 艾滋病毒是目前吸烟者。南非政策支持筛查吸烟和戒烟工作 这些都包括在南非国家抗逆转录病毒疗法（ART）指南中，南 非洲STG-EML和南非临床实践指南。目前，在小学进行吸烟筛查 护理环境的水平很低，戒烟干预措施的提供甚至更低。有效的支持战略 为减低爱滋病病毒感染及吸烟引致的负担， 合并症。我们发现，社会和人际压力以及难以管理的渴望是 在南非，PWH吸烟者戒烟的障碍。为资源匮乏环境制定的干预措施 经常解决这些近端的预测和调解的停止，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 基于证据的戒烟干预措施，以解决这些确定的挑战：（1）密集 行为咨询，（2）同伴咨询，（3）尼古丁替代疗法，和（4）伐尼克兰。 干预措施的制定由多阶段优化治疗策略（MOST）指导， 开发、优化和评估干预措施，同时考虑时间和财政资源， 以及实施的可行性和成本。在MOST的优化阶段，我们的第一个目标是评估 这些干预措施在PWH中的主要作用和相互作用。第二个目标将描述 使用Reach提供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 持续发展第三个目标将比较戒烟的成本、成本效益和预算影响 作为常规项目实施的干预措施。结果将告知戒烟的发展 为参与南非艾滋病毒项目的PWH优化的治疗包。

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.