BACKGROUND: Botswana faces a high prevalence of HIV, along with significant smoking rates and limited access to cessation interventions. The Botswana Smoking Abstinence Reinforcement Trial (BSMART) evaluates the effectiveness of combining Screening, Brief Intervention, and Referral to Treatment (SBIRT) with varenicline, delivered by lay health workers (LHWs) and nurse prescribers and dispensers (NPDs) within routine HIV care.
METHODS: BSMART utilizes a stepped-wedge, hybrid Type 2 effectiveness-implementation framework comprising three steps across fifteen HIV facilities, enrolling participants in both control and intervention phases. During the intervention phase of step one sites, LHWs, and NPDs from a national referral hospital (NRH), two district hospitals, and two clinics received training on the implementation of SBIRT alongside varenicline delivery. Adults living with HIV were screened for smoking by LHWs. Those who met the inclusion criteria- ≥18 years old and on antiretroviral therapy (ART) for at least six months and consented to participate were offered SBIRT and referrals to varenicline-supported cessation services provided by the trained NPDs. Training for LHWs and NPDs was conducted at the study sites in July 2024, with participant recruitment occurring from September 2024 to January 2025.
RESULTS: Twenty-seven healthcare providers were trained across five sites including 13 of 14 (93%) LHWs and 14 of 18 (78%) NPDs. Of 2044 individuals screened, 180 (8.8%) self-reported as smokers, of whom 140 (77.8%) met the criteria for enrollment. Among eligible participants, 125 (89%) consented to participate and received SBIRT. Of those who received SBIRT, 112 (80%) were eligible for varenicline, and all 112 (100%) accepted a referral to cessation services, with all initiating varenicline treatment.
CONCLUSIONS: Step one intervention phase of the BSMART demonstrates the feasibility of integrating smoking cessation interventions into routine HIV care, highlighting the potential for scalable and sustainable strategies to reduce smoking prevalence among PLWH in similar low-resource settings.