Ending Tobacco Use through Interactive Tailored Messaging for Cambodian People Living with HIV/AIDS (EndIT) - PROJECT SUMMARY
Although the prevalence of tobacco use has declined in developed nations in recent decades, the prevalence
of smoking remains strikingly high in many low-income countries. In Cambodia, recent national surveys have
indicated that 33%–43% of adult men and 3% of adult women smoke cigarettes. Certain special populations,
such as people living with HIV (PLWH), are confronted with disproportionately high risks associated with
tobacco use. Available estimates indicate that 43%–65% of male PLWH and 3%–5% of female PLWH smoke
cigarettes. Although Cambodia has widespread coverage for antiretroviral treatment (ART), no known efforts
have been made to provide tobacco treatment to ART recipients who smoke. Thus, complementing ART with
efficacious tobacco cessation treatment offers tremendous potential to improve HIV care and to prolong life for
PLWH. To address this need, we propose a randomized controlled trial with pharmacological and behavioral
treatment components, including a fully automated, interactive smartphone-delivered intervention. Mobile
health (mHealth) interventions are proliferating in the US, but efforts to utilize similar approaches in Cambodia
are extremely limited. The World Health Organization acknowledges that mHealth is cost-effective, scalable,
and sustainable, including for the least developed countries. We have already developed the mHealth platform
and intervention approach proposed for this study, and we have completed a pilot study with 50 Cambodian
PLWH who smoked and received care at an ART clinic. Results from this pilot indicated that the biochemically
confirmed, 7-day point prevalence abstinence rates at 2-months follow-up were 40% in the group receiving the
mHealth intervention vs. 8% in a standard care control group (relative risk: 5.0). In this proposed study,
Cambodian PLWH of all sexual identities will be recruited through the 6 largest ART clinics in Phnom Penh,
which provide comprehensive care to more than 14,000 PLWH. Participants (n=800) will be randomized to one
of 2 treatment groups: Standard Care (SC; n=400), or Automated Messaging (AM; n=400). SC consists of brief
advice to quit smoking delivered by research staff, self-help written materials, and an 8-week supply of nicotine
replacement therapy (NRT) in the form of transdermal patches. AM consists of the SC components plus a fully
automated smartphone-based treatment program that involves interactive and tailored proactive messaging.
The primary outcome is biochemically confirmed self-reported 7-day point prevalence abstinence at 12-months
post-study enrollment. Secondary outcomes include abstinence at 3- and 6-months post-enrollment. The
primary aims are to evaluate the efficacy of AM for Cambodian PLWH who smoke and to compare the cost-
effectiveness of AM vs. SC. If our findings indicate that AM is efficacious and cost-effective, our collaboration
with influential Cambodian governmental agencies will facilitate wide-scale implementation to HIV clinics
across the country. Thus, the project has the potential to transform HIV care delivery throughout the country
and to reduce tobacco-induced cancer morbidity and mortality significantly.
