Grant Details
Grant Number: |
1R01CA240481-01A1 Interpret this number |
Primary Investigator: |
Shelley, Donna |
Organization: |
New York University |
Project Title: |
Implementing Tobacco Use Treatment in HIV Clinics in Viet Nam |
Fiscal Year: |
2020 |
Abstract
ABSTRACT
Male smoking prevalence in Viet Nam is one of the highest in the world (45%), and smoking rates are even
higher among people living with HIV/AIDS (PLWH) (59%). PLWH who smoke are at increased risk of excess
morbidity and premature death compared with nonsmokers. Yet, in Viet Nam treatment is not integrated as a
routine part of care in outpatient HIV clinics (OPCs). 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
like Viet Nam. The objective of this study is to conduct a 3-arm randomized controlled trial (RCT) that
compares the cost-effectiveness of three multi-component interventions that are embedded in OPCs: 1)
3As+R (Standard Care (SC)): Ask about tobacco use, Advise to quit, Assist (brief counseling), and Refer to
Viet Nam’s national Quitline; 2) SC+Counsel (Counsel=6-session cessation counseling intervention adapted
for PLWH and delivered by a trained, onsite clinic staff; and 3) SC+Counsel+N (N=nicotine replacement
therapy (NRT)). The primary outcome of this type 1 hybrid implementation trial is the effectiveness of the
intervention (6-month tobacco abstinence) and secondary outcomes are measures of contextual factors that
may influence implementation and sustainability. Patients (n=672) will be recruited from 14 OPCs in two cities
in Viet Nam and randomized into one of 3 study arms. The proposal builds on findings from the team’s 2-arm
NCI-funded cluster RCT (VQUIT) that compared two implementation strategies for increasing adoption of TUT
guidelines in 26 health centers that provide primary care for a general population in Viet Nam. In VQUIT, which
was implemented prior to the availability of the Quitline, clinicians in the intervention sites referred tobacco
users to a trained village health worker (VHW) for 3-session cessation counseling. Control sites included a 3As
only model and no referral option. Patients receiving VHW-delivered counseling plus clinician-delivered
cessation advise and counseling (3As+R) had higher biochemically validated 6-month quit rates compared with
those who received 3As only (25.7% vs.10.5%; p<.001). This proposal builds logically on this prior work. We
will conduct formative research to further adapt and tailor the VQUIT materials to the sociocultural context of
PLWH and to the HIV clinical context. We will then compare the 3As+R model (Standard care (SC) now with
Quitline referral) to two enhanced models of TUT that offer: a) more intensive counseling adapted for PLWH
and delivered by HIV clinicians (SC+Counsel), and b) dispensing of NRT (SC+Counsel+N). The specific aims
are to: 1) Adapt and tailor the intervention to PLWH and HIV care settings, 2) Conduct a 3-arm RCT comparing
the cost effectiveness of three models of care based on biochemically validated 6-month smoking abstinence;
and 3) Evaluate multilevel factors that facilitate or impede implementation and potential for sustainability of
TUT in HIV treatment settings in Viet Nam.
Publications
Depression and associated factors among HIV-positive smokers receiving care at HIV outpatient clinics in Vietnam: a cross-sectional analysis.
Authors: Nguyen N.T.
, Nguyen T.
, Vu G.V.
, Truong N.
, Pham Y.
, Guevara Alvarez G.
, Armstrong-Hough M.
, Shelley D.
.
Source: BMJ open, 2024-02-13; 14(2), p. e077015.
EPub date: 2024-02-13.
PMID: 38355191
Related Citations
Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study.
Authors: Shelley D.
, Alvarez G.G.
, Nguyen T.
, Nguyen N.
, Goldsamt L.
, Cleland C.
, Tozan Y.
, Shuter J.
, Armstrong-Hough M.
.
Source: Implementation science communications, 2022-10-17; 3(1), p. 112.
EPub date: 2022-10-17.
PMID: 36253834
Related Citations