Global Health Profile Series: An Innovative Smoking Cessation Intervention for People Living with HIV in Nepal

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By Lauren A. Amorin, Marshall Crescentini, Megan Michta, and Jodi Zizmor

MPH students Lauren A. Amorin, Marshall Crescentini, Megan Michta, and Jodi Zizmor examine an innovative new smoking cessation intervention for people living with HIV in Nepal led by Associate Professor Krishna Poudel. Their interview is part of the new Global Health Profile Series.

There is a great burden of tobacco use-related harms among people living with HIV (PWH), and although the prevalence of tobacco use is generally progressively declining, a disproportionate use has been observed among this population. There is, therefore, a need to address this, especially in low- and middle-income countries (LMICs) where tobacco cessation programs are not common. Dr. Krishna Poudel, Associate Professor of Community Health Education and Director of the Institute for Global Health at the University of Massachusetts Amherst, has a great interest in health promotion and disease prevention among PWH. His research has spanned the globe; he has worked with PWH for many years and has published many articles regarding HIV transmission risk behavior determinants, evaluation of behavior change determinants, and other related factors. He is also interested in advocating for translation of research findings into practice. Dr. Poudel recently designed and implemented a tailored video-based smoking cessation program to address tobacco smoking among people living with HIV in Nepal, a resource-limited country. We interviewed him to learn more about his approach and the findings of this research.

Dr. Poudel’s intervention took place among PWH attending the HIV clinic of Sukraraj Tropical and Infectious Disease Hospital (STIDH), which is the largest HIV clinic in Nepal. The intervention consisted of eleven 3-8 minute video clips that provided participants with the information needed to quit smoking and maintain abstinence. Every participant received a personalized schedule for video watching based on their selected quit day. Each video clip encouraged participants to identify barriers they face in each stage of the cessation process as well as strategies to address them. The videos directly targeted issues facing PWH in Nepal, so participants felt connected and knew that the curriculum was built specifically for their community.

Per its personalized and supportive nature, the intervention was particularly successful in maintaining participant engagement. By the end of the study period, there was no loss to follow-up, and 96 percent of participants had watched all of the video clips. Moreover, with a seven-day abstinence rate of 40 percent (confirmed by expired carbon monoxide levels) at a 3-month follow-up, the intervention was highly effective in encouraging smoking cessation among PWH. Additionally, more than 80% of study participants who did not successfully quit, did make an attempt to do so during the study period. During post-intervention interviews, all of the study participants expressed high levels of satisfaction with the intervention and concluded they would recommend it to their HIV-positive friends who smoke.

To Dr. Poudel’s knowledge, this study is the first of its kind to implement video-based smoking cessation intervention among PWH in a resource-limited setting. The findings of the study indicate that the intervention may reduce smoking-associated morbidity and mortality rates among PWH in Nepal and likely other LMICs. The intervention is thus likely to improve both the quality of life and health of PWH. Prospectively, the video-based smoking cessation intervention has the potential to be translated into other languages and its content replicated to be culturally relevant towards other populations. Similarly, the idea behind using video-based interventions to change a health behavior within a target population can be applied to other health issues.

To expand upon this research, Dr. Poudel is also currently working to create a smartphone application targeted towards smoking cessation among PWH using the videos from the intervention, as well as new features such as messaging to other participants and providers and tracking of smoking usage. The app will allow the intervention to reach more PWH and increase the ability to track patient progress, with the aim of increasing the proportion of patients who successfully quit smoking.

Dr. Poudel’s publication, “Feasibility, Acceptability, and Preliminary Effects of a Video-Based Intervention for Smoking Cessation Among People with HIV in Kathmandu, Nepal: A Single-Armed Pilot Study”, detailing these findings is now available online ahead of print in AIDS and Behavior.

About the Interviewers

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MPH student Lauren Abla Amorin

Lauren A. Amorin '23MPH holds a professional doctorate in pharmacy (PharmD) and recently earned her MPH degree with a concentration in Community Health Education from UMass Amherst. She is looking to merge her work as a pharmacist and a public health professional to continue to promote health at both the individual and community level.

Marshall Crescentini is an MPH student in the Health Policy and Management program.

Megan Michta is a student in the 4+1 accelerated MPH degree in Epidemiology program.

Jodi Zizmor is a student in the 4+1 accelerated MPH degree in Community Health Education program.