Utilization of cessation resources among HIV-positive and HIV-negative men who smoke and who have sex with men in Chengdu, China

Factors Related to Smoking and Perceptions of a Behavioral Counseling and Messenger Service-Delivered Smoking Cessation Intervention for People with HIV in China: A Qualitative Study (Preprint)

Background

China, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population.

Objective

This study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages.

Methods

We recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups.

Results

A total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level.

Conclusions

We identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China.

Smoking and cessation-related attitudes among men who have sex with men in the country of Georgia

Among men who have sex with men (MSM) in low- or middle-income countries, smoking and related factors have been understudied. We examined correlates of smoking status, level, and importance and confidence regarding quitting among 608 MSM in the country of Georgia recruited in June-September, 2016 (493 without HIV via peer referral in 3 Georgian cities; 115 with HIV via the National AIDS Center). Median age was 26 years, 78.6% reported current (past 30-day) alcohol use, and 22.4% reported past-year illicit drug use. Overall, 73.8% reported current smoking; of these, 87.1% smoked daily, mean cigarettes per day (cpd) was 19.8, 64.6% smoked ≤30 min of waking, and mean quitting importance and confidence were 6.8 and 6.4 (0 = not at all to 10 = extremely), respectively. Multivariable analyses indicated that current smoking correlated with past-month alcohol and past-year illicit drug use (p's < .001). Among smokers, cpd correlated with being older and smoking within 30 min of waking; greater quitting importance (≥7) correlated with higher education and no illicit substance use; and greater quitting confidence (≥7) was associated with fewer cpd, smoking ≤30 min of waking, and regional versus capital city residence. Given these findings, addressing tobacco and other substance use among MSM in Georgia is critical.

A brief tobacco dependence intervention for people living with HIV in Nepal: results of a quasi-experimental study

Introduction

There is evidence of increased morbidity, decreased quality of life, and premature mortality in people living with HIV (PLHIV) who smoke tobacco compared to PLHIV who do not smoke tobacco. Evidence-based screening for tobacco dependence, pharmacological treatment, and treatment monitoring and education into relapse prevention are not readily available in low- and middle-income countries (LMIC). We evaluated the effects of a brief tobacco dependence intervention in improving knowledge on the health effects of smoking and intention to quit smoking in PLHIV in Nepal, a low-income country in south Asia.

Methods

Using a quasi-experimental design, we assigned 59 smokers to participate in the intervention and 67 in the control group. The 1.5 h smoking cessation intervention emphasized harms of smoking, reasons for smoking and quitting, causes of relapse in previous quit attempts, and quitting strategies. We collected data at baseline and immediately post-intervention.

Results

Findings indicate that a brief smoking cessation intervention produced a significant increase in smoking-related knowledge and intention to quit among PLHIV. The positive effects of our intervention remained significant after adjusting for potential confounders.

Conclusions

Our brief tobacco dependence intervention was effective in improving knowledge on the health effects of smoking and intention to quit among PLHIV. Further studies are required to evaluate the effectiveness of our intervention in increasing smoking cessation among PLHIV in LMIC.