Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Schroeder Institute for Tobacco Research and Policy Studies, Washington, DC.
Nicotine Tob Res. 2018 Aug 14;20(9):1117-1123. doi: 10.1093/ntr/ntx139.
In South Africa, people living with HIV have a high prevalence of smoking, which undermines the beneficial effects of antiretroviral therapy. However, little is known about barriers to smoking cessation and what interventions work for people living with HIV in this setting.
A randomized trial comparing intensive anti-smoking counseling versus counseling and nicotine replacement therapy was recently concluded in Klerksdorp, South Africa. In a post-trial follow-up, 23 in-depth interviews with patients and one focus group discussion with counselors from the trial were conducted. A codebook was developed and codes were applied to the transcripts, which were analyzed using a thematic analysis.
Barriers at the economic, social/interpersonal, and individual levels induced stress, which hindered smoking cessation. Economic stressors included unemployment and poverty. Social or interpersonal stressors were lack of social support for quitting smoking and lack of social support due to having HIV. Individual stressors were traumatic life events. Alcohol was used to cope with stress and frequently co-occurred with smoking. Managing cravings was a barrier unrelated to stress. Participants proposed income and employment opportunities, group counseling, and more frequent counseling as solutions to address stressors at different levels. Nicotine replacement therapy was helpful to mitigate cravings.
Future smoking cessation interventions need to target barriers at multiple levels. Increasing the supply and duration of nicotine replacement therapy may increase its effectiveness. Other behavioral approaches such as group counseling or peer counseling could hold promise in this setting but need to be tested for efficacy through randomized controlled trials.
To our knowledge, this is the first qualitative study examining barriers to smoking cessation for people living with HIV in South Africa. Smoking is highly prevalent among people with HIV in South Africa and cessation interventions are urgently needed. A better understanding of barriers to smoking cessation that people with HIV face will lead to the development of contextually appropriate interventions. This study also provides feedback on interventions from a recently concluded smoking cessation randomized trial and will help guide the design of future smoking cessation trials.
在南非，感染艾滋病毒的人吸烟率很高，这削弱了抗逆转录病毒疗法的有益效果。然而，人们对导致他们难以戒烟的障碍因素以及在这一环境下针对艾滋病毒感染者开展哪些干预措施有效知之甚少。
最近在南非克莱克斯多普结束了一项比较强化戒烟咨询与咨询加尼古丁替代疗法的随机试验。在试验后的随访中，对 23 名患者进行了深入访谈，并与试验中的咨询师进行了一次焦点小组讨论。制定了一个编码手册，将代码应用于转录本，然后使用主题分析对其进行分析。
经济、社会/人际关系和个人层面的障碍导致压力，从而阻碍了戒烟。经济压力源包括失业和贫困。社会或人际关系压力源包括缺乏戒烟的社会支持以及因感染艾滋病毒而缺乏社会支持。个人压力源包括创伤性生活事件。饮酒被用来应对压力，而且常常与吸烟同时发生。应对烟瘾是一个与压力无关的障碍。参与者提出了增加收入和就业机会、小组咨询以及增加咨询频率等解决方案，以解决不同层面的压力源。尼古丁替代疗法有助于减轻烟瘾。
未来的戒烟干预措施需要针对多个层面的障碍。增加尼古丁替代疗法的供应和持续时间可能会提高其效果。在这种环境下，其他行为方法，如小组咨询或同伴咨询可能有前景，但需要通过随机对照试验来测试其疗效。
据我们所知，这是第一项在南非研究艾滋病毒感染者戒烟障碍的定性研究。南非艾滋病毒感染者的吸烟率很高，迫切需要开展戒烟干预措施。更好地了解艾滋病毒感染者戒烟面临的障碍将有助于制定出适合具体情况的干预措施。本研究还对最近结束的戒烟随机试验中的干预措施提供了反馈，将有助于指导未来戒烟试验的设计。
