BACKGROUND: People Living with HIV (PLHIV) have higher smoking rates than the general population, making it essential that tobacco cessation interventions be integrated into HIV care. This study describes the congruence between self-report cessation rates and exhaled carbon monoxide (CO) at 1, 3, 6 and 12 months from the start of the intervention
METHODS: A cluster randomized superiority trial with participants randomized 1:1 to receiving brief intervention (5As and referral to quitline) and intensive intervention, (5As, NRT, Bupropion and text messages for 12 weeks). At 1, 3, 6 and 12 months after enrollment, participants were asked to self-report cessation (answering “not at all” when asked about tobacco use) and had exhaled CO measured. Descriptive statistics, and chi-square were used to compare self-report with measured CO, with <5 ppm used as the cut-off for cessation and > 5 ppm as continuing smoking.
RESULTS: We enrolled 580 participants, 290 in each arm, median age 47 years and 98% male. Congruence of self reported smoking cessation was 81.4%, 67.4%, 77.1%, 72.7% and 57.5%, 64.1%, 66.7%, 60.6% at 1-, 3-, 6-, and 12-months time points in the brief intervention arm and intensive intervention arm respectively. At month 1, self reported smoking cessation was more likely to be congruent with exhaled CO in the brief arm compared to the intensive arm (p=0.009) with no statistically significant differences in congruence between the arms in the subsequent months.
CONCLUSIONS: This is the first study to assess smoking cessation among PWH in Kenya. We found some congruence between self-reported cessation and exhaled CO levels. The differences between arms should be explored through qualitative methods to understand the challenges and limitations of self-report. Biochemically verification through exhaled CO was an important factor to determine cessation. It also served to provide participants with feedback on their status and encourage participants to stay quit.