XIX International AIDS Conference


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THPE045 - Poster Exhibition

Reducing tobacco-associated morbidity and mortaltiy among people living with HIV (PLHIV): prevalence, screening and treatment referrals

B. Agins1, W. Chow2, A. Bowes1, D. Ng1, K. Schneider2, C. Wells1, T. Matthews3, L. Hirschhorn2

1NYS Dept of Health AIDS Institute, HIVQUAL-US, New York, United States, 2JSI Research and Training Institute, Inc., Boston, United States, 3HRSA, HIV/AIDS Bureau, Rockville, United States

Background: Tobacco use among people living with HIV/AIDS (PLWHA) threatens the improvements in life expectancy and quality of life made possible by antiretroviral therapy. Targeted screening and cessation programs are imperative to reduce the burden of tobacco-related morbidity and mortality among PLWHA from cancer, cardiovascular disease, and pulmonary disease.
We describe rates of screening , active use and receipt of cessation counseling and patient factors associated with differences in receipt of these interventions in a national sample of clinics participating in HIVQUAL-US, a national quality improvement (QI) capacity building initiative.
Methods: HIVQUAL-US supports clinics funded through the Ryan White HIV Program to provide care to underserved populations in the United States. Clinics submit patient-level performance measurement data including tobacco screening during the review year and cessation counseling for active users . Univariate analysis and multivariate logistic regression using GEE were used with p< .05 considered significant.
Results: Two-hundred and four clinics submitted data on 10,819 patients (mean 53 per clinic). The average clinic rates for tobacco use screening was 81.7% (range 17.5-100%), with 42.3% of patients reporting active use (range 0-100%), of whom an average 77.9% (range 0-100%) received cessation counseling. Rates among different settings and patient groups are summarized in table 1.

Univariate ResultsTobacco Use ScreeningCurrent UseCessation Counseling
Overall80.4% (8701/10819)42.1% (3663/8701)77.4% (2834/3663)
GENDER: Male/ Female80.6%/ 80.3%46.3%**/ 42.4%75.9%**/ 79.9%
IDU RISK: Yes/ No83.7%**/ 80.0%69.2%***/ 41.0%76.4%/ 77.6%
MINORITY: Yes/ No80.1%/ 81.7%42.1%/ 53.6%***77.2%/ 77.9%
AGE 50+: Yes/ No81.6%**/ 79.9%43.7%/ 45.5%79.8%**/ 76.0%
Hospital clinic/ Health center-ASO81.1%/ 80.1%44.7%/ 44.9%81.6%/ 74.6%
*P<0.05; **P<0.01; ***P<0.0001
[Univariate Results]

In the multivariate model (table 2), patients with IDU risk were more likely to be screened and use tobacco, but less likely to have documentation of cessation counseling. PLWHA who were > 50 years and from racial/ethnic minorities were less likely to report current use, with no differences seen on screening or cessation counseling.

CharacteristicTobacco Use ScreeningCurrent UseCessation Counseling
Male0.96 (0.87-1.06)1.10 (1.00-1.21)0.98 (0.85-1.14)
IDU Risk1.23 (1.07-1.42)**2.86 (2.50-3.26)***0.84 (0.74-0.95)**
Minority0.91 (0.80-1.04)0.66 (0.57-0.76)***0.87 (0.75-1.01)
Over 501.00 (0.91-1.09)0.77 (0.70-0.85)***1.06 (0.91-1.22)
Hospital-based clinic0.90 (0.56-1.46)1.01 (0.82-1.23)1.23 (0.73-2.07)
Adjusted odds ratios (95% CI) shown.
Reference categories: female, no IDU risk, white non-Hispanic; age 50 or below; non-hospital clinic
*p<o.05; ** p<0.01; ***p<0.0001
[Multivariate Results]

Conclusions: Screening rates were relatively high but leave room for improvement. High rates of tobacco use were seen highlighting the need for increasing work to ensure delivery of effective services to help PLWHA reduce tobacco-associated morbidity and mortality

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