BACKGROUND: Botswana experiences a high prevalence of smoking, compounded by a significant burden of HIV, yet lacks smoking cessation interventions within HIV care facilities. The study assesses the effectiveness of evidence-based smoking cessation strategies in a real-world context. During the control phase, an enhanced standard care package included one counseling session at enrollment, complemented by a brochure.
METHODS: We utilized a stepped-wedge design for the Botswana Smoking Abstinence Reinforcement Trial (BSMART). Recruitment occurred from June 2023 to February 2024 at five HIV care facilities in Botswana. Clients on Anti-Retroviral Treatment (ART) for at least six months who smoked daily were eligible for enrollment and followed for six months. Self-reported smoking cessation was defined as abstaining for seven or more consecutive days, was documented at week 24 and verified through carbon monoxide (CO) measurements, with a CO level of ≤6 parts per million (ppm) indicating smoking abstinence.
RESULTS: A total of 1750 individuals were screened for smoking, with 202 (12%) identifying as smokers. Among these, 125 met the eligibility criteria and enrolled in the study, with a predominance of male participants (90%). The average age of participants was 45.3 years, with an average smoking duration of 23.7 years. At the 24-week visit, 85 of the 116 (73.3%) participants who attended reported making at least one quit attempt since their last visit. Those who attempted to quit reported an average of 27.5 days of abstinence during these attempts. Notably, 23 out of 125 participants (18%) self-reported having quit smoking, of which 14 (61%) were verified through CO testing, and 10 (71.4%) were males.
CONCLUSIONS: The implementation of smoking cessation interventions in Botswana’s HIV care settings holds promise for encouraging quit attempts among clients. The use of biochemical validation confirmed self-reported cessation, which underscores the potential effectiveness of integrating smoking cessation strategies in this context.