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.

项目概要 吸烟是全世界发病率和死亡率最可预防的原因之一，并且已 成为非洲发展中国家日益严重的流行病。在接受抗逆转录病毒治疗的艾滋病病毒感染者中 治疗中，吸烟导致的生命年损失比艾滋病毒感染还要多。虽然行为方法和 药物治疗通常在高收入国家一起使用，但药物治疗基本上不可用 由于成本原因，在撒哈拉以南非洲地区。相反，制定和评估戒烟行为 可以切实传播的干预措施是解决人们吸烟问题的优先事项 在博茨瓦纳等国家感染艾滋病毒。然而，艾滋病毒的独特之处（例如，抑郁症状的发生率很高） 必须考虑在此类环境（例如分散的、有限的基础设施）中提供护理 为博茨瓦纳等中低收入国家设计行为方法。 博茨瓦纳的结核病病例中有 60% 是艾滋病病毒感染者，这使得结核病护理系统成为一个关键环境 鉴于结核病护理的独特结构需要密切的医疗保健，考虑提供烟草护理 后续行动并设有社区卫生工作者等内置服务。吸烟与 感染风险增加和结核病结果较差。烟草使用进一步对艾滋病毒感染的结果产生不利影响 结核病共同感染者。虽然国际指南建议将戒烟纳入结核病防治范围 控制规划中，戒烟服务尚未普遍纳入结核病或结核病/艾滋病毒控制 世界各地的计划，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，关于戒烟的实施和扩大规模的数据有限 结核病控制规划中的策略。 该项目将利用实施科学原理和方法，采用定性方法 确定对艾滋病病毒感染者实施戒烟干预措施的障碍和促进因素 在博茨瓦纳的结核病治疗项目中，医疗服务机构通常与艾滋病毒诊所分开。它将增强 我们对影响戒烟服务实施的因素的理解具有独特和 中低收入国家的重要环境和人口。这项工作将指导后续的设计和临床研究 在此背景下实施针对特定地区的烟草使用治疗措施。