Testing the Combination of Behavioral Activation and Problem Solving as a Novel Behavioral Smoking Cessation Intervention for Smokers with HIV in Botswana

University Of Pennsylvania, Philadelphia PA

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Abstract

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.