Abstract 3: Adapting a Tobacco Cessation Treatment Intervention and Implementation Strategies to Enhance Implementation Effectiveness and Clinical Outcomes in the Context of HIV Care in Viet Nam: A Case Study
Authors: Shelley Donna , Armstrong-Hough Mari , Goldsamt Lloyd , Alvarez Gloria Guevera , Nguyen Trang , Nguyen Nam 
Published: June 2023

Purpose: In Vietnam, tobacco use among men living with HIV/AIDS (PLWH) is substantially higher than among the general population. Tobacco use is responsible for significant disparities in cancer-related health outcomes among PLWH who smoke compared with nonsmokers. Despite the burden of disease, there is a lack of evidence for effective treatment for PLWH. We conducted a randomized-controlled trial comparing the effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV outpatient clinics (OPCs).

Methods: Patients identified as current cigarette and dual use smokers at the time of their visit (waterpipe and cigarettes) (n=288) were recruited and randomized into one of three interventions: 1) 3As (Ask about tobacco use, Advise to quit, Assist with brief counseling delivered by physicians)+R (proactively Refer to Vietnam’s National Smoker’s Quitline); 2) 3As+Counsel (6-session counseling intervention tailored to PLWH and delivered by trained nurses); and 3) 3As+Counsel+N (nicotine replacement therapy). The primary outcome is six-month carbon monoxide-confirmed smoking abstinence. We are also assessing hypothesized mediators (e.g., self-efficacy, social support). A formative assessment guided adaptation of the intervention to the local context and population.

Results: Mean age was 42.4, 96% of patient were male, 8% live alone, 91% are employed, 53.8% were dual users, mean # cigarettes smoked per day was 15.9, and 21.9% reported drug use in the past 3 months. There were no differences across arms in baseline rates of clinical depression or substance use. At 3 months (n=211, those eligible to date), 45% in Arm 1 and 2, and 43.5% in Arm 3, reported smoking abstinence. Among those eligible and reached (98%) for the 6-month survey, 35.9%, 28.9% and 38.3% reported abstinence respectively. Six-month CO- confirmed quit rates were 15.1, 13.3 and 21.3% respectively. 91% of patient received at least one Quitline call and 94% completed 6 sessions of counseling.

Discussion: Results are promising and indicate that smoking cessation interventions adapted for PLWH and delivered by health care providers as part of routine care can be effective. The study is the first to demonstrate the feasibility of integrating a Quitline referral system in the context of HIV care. Therefore, the similar outcome across arms has important policy implications; the Quitline is a sustainable resource requiring fewer OPC resources than more intensive counseling.

Citation Format: Donna Shelley, Mari Armstrong-Hough, Lloyd Goldsamt, Gloria Guevera Alvarez, Trang Nguyen, Nam Nguyen. Adapting a Tobacco Cessation Treatment Intervention and Implementation Strategies to Enhance Implementation Effectiveness and Clinical Outcomes in the Context of HIV Care in Viet Nam: A Case Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 3.