IMPLEMENTING TOBACCO USE TREATMENT IN HIV CLINICS IN VIET NAM
Male smoking prevalence in Viet Nam is among the highest in the world (45%). Rates of tobacco use are even higher among HIV+ men (59%). Smoking rates among women remain <2%. There are over 300,000 people living with HIV/AIDS (PLWH) in Viet Nam. Those who smoke are at increased risk for a host of serious HIV-related and non-HIV-related co-morbidities compared with HIV+ nonsmokers. Despite the high smoking rates and adverse impact of tobacco use among PLWH, tobacco cessation treatment is unavailable in outpatient HIV clinics (OPCs), the primary source of HIV care for PLWH in Viet Nam.
Our long-term goal is to develop a scalable model for implementing evidence-based tobacco use treatment (TUT) in health care settings treating PLWH in LMICs such as Viet Nam. The objective of this project is to conduct a 3-arm randomized controlled trial (RCT) that compares the effectiveness and cost-effectiveness of three practical multilevel, multicomponent tobacco cessation interventions in OPCs.
This project is the first to implement an integrated smoking cessation as part of routine health care at HIV examination and treatment facilities in Vietnam.
This project is implemented by Institute of Social and Medical Studies, New York University and Vietnamese investigators from Hanoi University of Public Health, Tobacco Control Fund, Vietnam Administration of HIV/AIDS Control – Ministry of Health, funded by NIH. The project will be implemented at 14 HIV clinics in Hanoi from 2021 to 2025.
Specific aims are:
1) To further adapt and tailor a multicomponent tobacco cessation intervention to the unique sociocultural context of PLWH and the HIV outpatient clinical context by collecting and analyzing data from 8 focus groups with HIV-infected tobacco users, and conducting clinic site observations, surveys (n=98) and semi- structured interviews with clinicians (n=28) in 14 study sites.
2) To conduct a multisite three-arm RCT (n=672 PLWH in 14 OPCs) comparing the effectiveness and cost effectiveness of: 1) Standard Care: Ask, Advise Assist (brief counseling) and refer to Quitline, 2) SC+Counsel (Counsel=six sessions of in-person tobacco cessation counseling tailored to PLWH), and 3) SC+Counsel+N (N=4 weeks of nicotine patch). The primary outcome is biochemically validated 6-month, 7- day point prevalence abstinence..
3) Assess multilevel factors (e.g. org climate, provider beliefs) that facilitate or impede implementation and sustainability of a new model for TUT in HIV treatment settings in Viet Nam