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Principal Investigator: Manhattan E Charurat
Organization: UNIVERSITY OF MARYLAND BALTIMORE
Fiscal Year: 2024
Award: $699,789
Funding agency: National Cancer Institute
PROJECT ABSTRACT
Tobacco use is highly prevalent among people living with HIV/AIDS (PLWH) especially in southern Africa where
HIV is most heavily concentrated. Among PLWH, tobacco use impacts HIV-related co-morbidities and is the
leading cause of premature mortality from non-HIV related malignancies such as lung cancer which account for
20% of the cancer burden. Integrating an evidence-based intervention, such as Screening, Brief Intervention and
Referral to Treatment (SBIRT) into a HIV care system presents an important opportunity to establish and
evaluate a modifiable cancer prevention strategy into a low- and middle-income country (LMIC) setting where
both lay health workers (LHW) and non-physician clinicians are widely used. Botswana, where the University of
Maryland Baltimore (UMB) has worked since 2015, oversees a wide network of HIV care clinics for its citizens.
Demographic Health Surveys from sub-Saharan Africa show that smoking prevalence among PLWH ranges
12.5-44.3%. Yet, based on our pilot data the system of care is highly unprepared to meet the challenge of
integrating evidence-based smoking cessation treatment into routine HIV care. The Government of Botswana
wants more to be done to assist its citizen in smoking cessation. To meet this challenge, the Botswana Smoking
Abstinence Reinforcement Trial (BSMART) proposes to use a Type 2 hybrid effectiveness-implementation study
design to evaluate the effectiveness and implementation of a well-established SBIRT intervention consisting of
the 5As, (Ask, Advise, Assess, Assist, Arrange) delivered by trained LHW case managers, followed by referral
to treatment with varenicline (a medication demonstrated to be efficacious for smoking cessation among
PLWH1-3 and on formulary in Botswana) prescribed and monitored by trained nurse prescribers-dispensers, in
the network of outpatient HIV care facilities in Botswana. The specific aims guided by the RE-AIM Framework
and informed by an Implementation Governance Structure are to: 1) Assess Reach and Effectiveness of
BSMART; 2) Assess the Adoption and Implementation indexed by quality and consistency of intervention
delivery; 3) Assess whether the intervention becomes Maintained as part of routine practices; 4) Determine the
preliminary cost-effectiveness of BSMART.
Terms: <AIDS Virus><AIDS/HIV><Abstinence><Acquired Immune Deficiency Syndrome Virus><Acquired Immunodeficiency Syndrome Virus><Active Follow-up><Address><Adoption><Africa South of the Sahara><Agreement><Assessment instrument><Assessment tool><Baltimore><Bechuanaland><Biochemical><Botswana><Cancer Burden><Cancer Control><Cancer Control Science><Cancers><Care Manager><Caring><Case Manager><Clinic><Clinical effectiveness><Control Groups><Data Systems><Demographic and Health Surveys><Development><Drugs><Effectiveness><Evidence based intervention><Formularies><Fostering><Government><HIV><HIV Infections><HIV/AIDS><HTLV-III Infections><HTLV-III-LAV Infections><Health><Health Facilities><Health care facility><Health system><Healthcare Facility><Human Immunodeficiency Viruses><Human T-Lymphotropic Virus Type III Infections><IT Systems><Information Systems><Information Technology Systems><Infrastructure><Intervention><Intervention Strategies><LAV-HTLV-III><LMIC><Lymphadenopathy-Associated Virus><Malignant Neoplasms><Malignant Tumor><Malignant Tumor of the Lung><Malignant neoplasm of lung><Maryland><Medication><Monitor><NIH><National Cancer Burden><National Institutes of Health><Nurses><Out-patients><Outpatients><Participant><Persons><Pharmaceutical Preparations><Policies><Population><Premature Mortality><Prevalence><Preventative strategy><Prevention strategy><Preventive strategy><Program Sustainabilities><Program Sustainability><Psychological reinforcement><Pulmonary Cancer><Pulmonary malignant Neoplasm><RE-AIM><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Recommendation><Reinforcement><Research Design><SBIRT><Sample Size><Smoking Cessation Intervention><Southern Africa><Structure><Study Type><Sub-Saharan Africa><Subsaharan Africa><Time><Tobacco><Tobacco Consumption><Tobacco use><Training><United States National Institutes of Health><Universities><Virus-HIV><Work><active followup><assess effectiveness><cancer prevention><care facilities><care services><care systems><cease smoking><clinical research site><clinical site><co-morbid><co-morbidity><combustible tobacco><comorbidity><cost effectiveness><design><designing><determine effectiveness><developmental><drug/agent><effectiveness assessment><effectiveness evaluation><effectiveness/implementation hybrid study><effectiveness/implementation study><evaluate effectiveness><evidence base><examine effectiveness><follow up><follow-up><followed up><followup><implementation fidelity><implementation science><implementation strategy><indexing><intervention delivery><intervention program><interventional strategy><low and middle-income countries><lung cancer><malignancy><neoplasm/cancer><nurse><program sustainment><programs><quit smoking><reach, efficacy, adoption, implementation, and maintenance><routine practice><screening, brief intervention, and referral to treatment><screening, brief intervention, referral, and treatment><smoking abstinence><smoking cessation><smoking cessation treatment><smoking prevalence><standard of care><stop smoking><strategies for implementation><study design><syndemic><synergistic epidemic><tobacco product use><tobacco products><trial comparing><varenicline>