While AIDS-related morbidity and mortality among people living with HIV (PLWH) have decreased with the introduction of combination antiviral therapy (ART), HIV continues to kill nearly 1 million people annually, the majority of whom live in sub-Saharan Africa. Tobacco use among PLWH contributes substantially to the HIV burden, with nearly a quarter of AIDS-related deaths attributable to smoking. While there is substantial evidence supporting interventions to help tobacco users in the general population quit, little is available relevant to the challenges facing HIV+ tobacco users, especially those living in low-income African countries, including higher rates of depressive symptoms, greater use of alcohol and illegal substances, lack of awareness about tobacco’s effects on HIV treatment, and social isolation resulting from HIV stigma.
We approach this gap with the first randomized control trial (RCT) to test the efficacy of a tailored short message service (SMS) based tobacco use cessation intervention on prolonged tobacco use abstinence at 6 months post program initiation in comparison to the standard of care (brief advice to quit) and nicotine replacement therapy (nicotine patches) among PLWH in Uganda and Zambia. Our study will provide insight into the efficacy, feasibility, applicability, and affordability of delivering tobacco cessation interventions through health care professionals at HIV treatment centers in two countries with different tobacco use patterns, policy environments, and health care resources and provide needed information to providers and policymakers looking for cost-effective tobacco cessation interventions.
The previously tested SMS-platform to be used in our study is uniquely positioned to be scaled in low- and middle-income countries worldwide, in which case rigorous research showing even modest success in reducing the prevalence of tobacco consumption among PLWH could confer enormous health and economic benefits. The primary partners in the study include the Center for Tobacco Control in Africa at the Makerere University School of Public Health, the Keck School of Medicine of USC; and the RAND Corporation; with technical support from the World Health Organization.