Prevalence of Risk Factors for Lung Cancer and Facilitators and Barriers for Tobacco Cessation among People Living with HIV

India has the world’s third largest HIV epidemic, with 2.1 million people currently living with HIV and an additional 90,000 new infections each year.[29] At the same time, expansion of the HIV response under India’s premier governmental agency - the National AIDS Control Organization (NACO), has led to an exponential growth in anti-retroviral treatment (ART) coverage from 7000 PLHIV in 2004 to more than 1 million by end of 2016.[30] As per the Global Adult Tobacco Survey (GATS), the prevalence of adult tobacco use is 28.6% (42.4% men and 14.2% women), with an overall smoking tobacco prevalence of 10.7% (19% men and 2% women) and a smokeless tobacco prevalence of 21.4% (29.6% men and 12.8% women) [REFERENCE?].  Alarmingly, both men and women in India who are HIV-infected are 20% more likely to use tobacco than people who are not HIV-infected, however data are scant[32]. Although the Indian Government offers a national tobacco quitline, and both nicotine replacement therapy and tobacco cessation services are cost-covered for the general population, these types of strategies are proving ineffective in most settings at reaching this highly vulnerable population of PLHIV.[33] As India is confronted with a growing HIV epidemic in setting of a well-established high prevalence of tobacco use that increases the risk of cancers, strategies are needed to provide directed, focused tobacco cessation intervention to the HIV population to prevent tobacco-related cancers. To design a targeted tobacco cessation intervention, better understanding of facilitators and barriers of existing tobacco cessation activities/programs is critical. The Health Behaviour Model (HBM) is one of the most widely used health behavior models that has been used extensively to organize theoretical predictors of preventive health actions. The HBM is a method used to evaluate and explain individual differences in preventative health behavior[34, 35] and it has been shown to be a good predictor for smoking behavior.[34]. We propose a study among PLHIV receiving out-patient care in a public ART center in Pune, India to: a) assess the prevalence of risk factors for lung cancers in PLHIV; b) assess attitudes, barriers and facilitators to tobacco cessation interventions using HBM constructs and c) evaluate the utility of lung health assessments, including “lung age” estimation, as a motivational tool for quitting among current tobacco users.

Primary Objectives

Aim 1. Assess the prevalence of risk factors of lung cancers including smoking and smokeless tobacco use, tuberculosis, pneumonia and COPD among men and women seeking HIV care in India.
Aim 2. Describe the socio-environmental context of combustible and smokeless tobacco use, assess attitudes, behaviors, and barriers to quitting tobacco, and determine preferred strategies for cessation support using the constructs of the HBM (perceived susceptibility, perceived barriers, perceived benefits, perceived self-efficacy, and cues to action) within HIV clinic care.
Aim 3. Assess the utility of lung health measures, such as FEV1 trajectories, percent-predicted lung function and lung age, as a motivational tool for smoking cessation.