Botswana Smoking Abstinence Reinforcement Trial (BSMART)

博茨瓦纳戒烟强化试验（BSMART）

基本信息

批准号：
10705316
负责人：
Manhattan E Charurat
金额：
$ 70.12万
依托单位：
UNIVERSITY OF MARYLAND BALTIMORE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-15 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10705316
关键词：
Abstinence Address Adoption Africa South of the Sahara Agreement Assessment tool Baltimore Biochemical Botswana Cancer Burden Cancer Control Caring Case Manager Clinic Clinical effectiveness Control Groups Demographic and Health Surveys Development Effectiveness Evidence based intervention Formularies Fostering Government HIV HIV Infections HIV/AIDS Health Health care facility Health system Information Systems Infrastructure Intervention Malignant Neoplasms Malignant neoplasm of lung Maryland Monitor Nurses Outpatients Participant Persons Pharmaceutical Preparations Policies Population Premature Mortality Prevalence Prevention strategy Program Sustainability Psychological reinforcement Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Design Sample Size Smoking Cessation Intervention Southern Africa Structure Time Tobacco Tobacco use Training United States National Institutes of Health Universities Work cancer prevention care systems clinical research site combustible tobacco comorbidity cost effectiveness design effectiveness evaluation effectiveness/implementation study evidence base follow-up implementation fidelity implementation science implementation strategy indexing intervention delivery intervention program low and middle-income countries programs routine practice screening, brief intervention, referral, and treatment smoking abstinence smoking cessation smoking prevalence standard of care syndemic tobacco products trial comparing varenicline

项目摘要

PROJECT ABSTRACT Tobacco use is highly prevalent among people living with HIV/AIDS (PLWH) especially in southern Africa where HIV is most heavily concentrated. Among PLWH, tobacco use impacts HIV-related co-morbidities and is the leading cause of premature mortality from non-HIV related malignancies such as lung cancer which account for 20% of the cancer burden. Integrating an evidence-based intervention, such as Screening, Brief Intervention and Referral to Treatment (SBIRT) into a HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy into a low- and middle-income country (LMIC) setting where both lay health workers (LHW) and non-physician clinicians are widely used. Botswana, where the University of Maryland Baltimore (UMB) has worked since 2015, oversees a wide network of HIV care clinics for its citizens. Demographic Health Surveys from sub-Saharan Africa show that smoking prevalence among PLWH ranges 12.5-44.3%. Yet, based on our pilot data the system of care is highly unprepared to meet the challenge of integrating evidence-based smoking cessation treatment into routine HIV care. The Government of Botswana wants more to be done to assist its citizen in smoking cessation. To meet this challenge, the Botswana Smoking Abstinence Reinforcement Trial (BSMART) proposes to use a Type 2 hybrid effectiveness-implementation study design to evaluate the effectiveness and implementation of a well-established SBIRT intervention consisting of the 5As, (Ask, Advise, Assess, Assist, Arrange) delivered by trained LHW case managers, followed by referral to treatment with varenicline (a medication demonstrated to be efficacious for smoking cessation among PLWH1-3 and on formulary in Botswana) prescribed and monitored by trained nurse prescribers-dispensers, in the network of outpatient HIV care facilities in Botswana. The specific aims guided by the RE-AIM Framework and informed by an Implementation Governance Structure are to: 1) Assess Reach and Effectiveness of BSMART; 2) Assess the Adoption and Implementation indexed by quality and consistency of intervention delivery; 3) Assess whether the intervention becomes Maintained as part of routine practices; 4) Determine the preliminary cost-effectiveness of BSMART.

项目摘要烟草使用在艾滋病毒/艾滋病患者 (PLWH) 中非常普遍，尤其是在南部非洲，那里 HIV最为集中。在艾滋病毒感染者中，烟草使用会影响艾滋病毒相关的合并症，并且是肺癌等非艾滋病毒相关恶性肿瘤导致过早死亡的主要原因 20%的癌症负担。整合循证干预措施，例如筛查、简短干预和 HIV 护理系统的转诊治疗 (SBIRT) 提供了一个重要的机会来建立和评估低收入和中等收入国家 (LMIC) 中可修改的癌症预防策略，其中非专业卫生工作者 (LHW) 和非医师临床医生都得到广泛使用。博茨瓦纳，大学所在地马里兰州巴尔的摩 (UMB) 自 2015 年起开始运作，为其公民监督广泛的艾滋病毒护理诊所网络。撒哈拉以南非洲地区的人口健康调查显示，艾滋病病毒感染者和艾滋病患者的吸烟率范围 12.5-44.3%。然而，根据我们的试点数据，护理系统还没有准备好应对以下挑战：将循证戒烟治疗纳入常规艾滋病毒护理中。博茨瓦纳政府希望采取更多措施帮助公民戒烟。为了应对这一挑战，博茨瓦纳吸烟局禁欲强化试验 (BSMART) 建议使用 2 类混合有效性实施研究旨在评估完善的 SBIRT 干预措施的有效性和实施情况，其中包括由经过培训的 LHW 案例经理提供 5A（询问、建议、评估、协助、安排），然后进行转介伐尼克兰治疗（一种药物已被证明对戒烟有效） PLWH1-3 和博茨瓦纳的处方集）由训练有素的护士处方者/配药者开处方和监测，博茨瓦纳的艾滋病毒门诊护理设施网络。 RE-AIM 框架指导的具体目标并通过实施治理结构通知的目的是： 1) 评估 BSMART； 2) 评估以干预措施的质量和一致性为指标的采用和实施送货; 3) 评估干预措施是否成为日常实践的一部分； 4) 确定 BSMART 的初步成本效益。