A phone-based tobacco use cessation program for people living with HIV in Uganda and Zambia: study protocol for a randomized controlled trial.

BACKGROUND: Nicotine replacement therapy (NRT) and short messaging service (SMS)-based tobacco cessation interventions have demonstrated effectiveness in reducing tobacco use in many populations, but evidence is needed on which tailored treatments are most efficacious in meeting the complex medical and psychosocial factors confronting people living with HIV (PLWH) in sub-Saharan Africa (SSA). This paper describes the protocol of a study to test the efficacy of both NRT and a tailored SMS-based tobacco use cessation intervention among PLWH in Uganda and Zambia. METHODS: In a randomized controlled trial, 800 adult PLWH who use tobacco will be recruited by health care professionals at HIV treatment centers where they are receiving care. Participants will be randomized to one of the four study arms: (1) standard of care [SOC; brief clinician advice to quit combined with HIV education and information aimed at encouraging HIV treatment adherence (with no mention of tobacco) delivered via text messages]; (2) SOC + 12 weeks of NRT; (3) SOC + 6 weeks of SMS text messages to support quitting tobacco use (SMS); or (4) SOC + NRT + SMS. Participants will receive a cell phone and solar panel with power bank for charging the phone. The main outcome is cessation of tobacco use by study participants verified by urinary cotinine (< 15 ng/mL) at 6 months post-enrollment. As a secondary tobacco use outcome, we will measure 7-day point-prevalence abstinence (7 consecutive days of no tobacco use) measured by self-report and biochemically-verified at 4 weeks, 8 weeks, and 3 months post enrollment. DISCUSSION: Our study will provide insight into the efficacy, feasibility and applicability of delivering tobacco cessation interventions through health care professionals combined with tailored tobacco cessation SMS text messaging 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 evidence of even modest success in reducing the prevalence of tobacco consumption among PLWH could confer enormous health and economic benefits. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT05487807. Registered August 4, 2022, https://clinicaltrials.gov/ct2/show/record/NCT05487807.

May Measurement Month 2019: an analysis of blood pressure screening results from Zambia.

In Zambia, hypertension accounts for the highest proportion of deaths due to cardiovascular diseases causing 3.3% of all deaths, killing an average of 670 people per year. May Measurement Month (MMM) is an annual global screening campaign aiming to improve awareness of blood pressure (BP) at the individual and population level. Adults (≥18 years) recruited through opportunistic sampling were screened at multiple sites within Lusaka during May and June 2019. Ideally, three BP readings were measured for each participant, and data on lifestyle factors and comorbidities were collected. Data were analysed centrally by the MMM project team and multiple imputations were performed where necessary. Of the total of 9232 enrolled, 8.7% of them had never had their BP measured, 2.5% had diabetes mellitus, 1.9% had had a myocardial infarction, 1.5% had had a stroke, 10.6% were current smokers, and 10.0% consumed alcohol once or more per week. Blood pressure fell from a mean of 128.6/82.9 mmHg for the 1st reading to a mean of 123.2/80.0 mmHg for the 3rd reading. The lowest proportion of participants with hypertension was identified by the 3rd reading alone (30.0%). Of all the participants, 30.7% had hypertension, though only 42.6% of them were aware of their diagnosis. Seven hundred and eighty-three (27.6%) were on antihypertensive medication though only 35.0% of them had controlled BP (systolic BP <140 mmHg and diastolic BP <90 mmHg). Compared with MMM17 data, there is deterioration of the monitored parameters calling for urgent and accelerated public health policy and clinical practice interventions. We think that the MMM campaign should continue annually to raise awareness of this treatable condition.