Improving tobacco cessation care for people living with HIV – News-Medical

Executive Summary: Advancing SDG 3 and SDG 10 Through Targeted Tobacco Cessation

A new research initiative at the Medical University of South Carolina (MUSC) aims to address a significant health disparity affecting people living with HIV. The project, ENHANCE-TTS (ENgaging pHarmacists to AdvANCE Tobacco Treatment Service), directly supports the achievement of Sustainable Development Goal 3 (Good Health and Well-being) and Sustainable Development Goal 10 (Reduced Inequalities). By developing and implementing a specialized smoking cessation program, the initiative seeks to reduce premature mortality from non-communicable diseases within a vulnerable population, thereby promoting health equity.

Project Overview: The ENHANCE-TTS Initiative

Addressing a Critical Health Disparity

Current data indicates that people living with HIV who smoke are more likely to die from lung cancer than from HIV-related causes. This population experiences disproportionately high rates of tobacco-related cancers, cardiovascular disease, and pulmonary complications. The ENHANCE-TTS program is designed to mitigate these adverse health outcomes.

Funding and Leadership

The project is supported by a five-year, $3 million grant from the National Heart, Lung, and Blood Institute. It is led by Dr. Alana Rojewski and Dr. Katherine Sterba of the Department of Public Health Sciences at MUSC’s Hollings Cancer Center.

Alignment with Sustainable Development Goals (SDGs)

SDG 3: Good Health and Well-being

The ENHANCE-TTS program makes a direct contribution to several targets within SDG 3:

• Target 3.4: By aiming to reduce mortality from lung cancer and other tobacco-related non-communicable diseases, the project directly addresses the goal of reducing premature mortality.
• Target 3.8: The program expands access to essential, evidence-based healthcare services (tobacco cessation treatment) for an underserved population, contributing to universal health coverage.
• Target 3.a: The initiative strengthens the implementation of the WHO Framework Convention on Tobacco Control by establishing a robust, clinic-based cessation program.

SDG 10: Reduced Inequalities

The project is fundamentally designed to reduce health inequalities by focusing on a specific and often marginalized population:

• It targets people living with HIV, a group facing unique health challenges and disparities.
• Implementation occurs within six Ryan White clinics, which are federally funded to provide HIV/AIDS care to individuals with limited or no insurance, ensuring that the intervention reaches those with the greatest need.

SDG 17: Partnerships for the Goals

The initiative exemplifies a multi-stakeholder partnership, uniting academic researchers (MUSC), a federal funding agency (National Heart, Lung, and Blood Institute), and multiple clinical service providers (Ryan White clinics) to achieve a common public health objective.

Methodology and Implementation

Program Strategy

The core strategy involves training clinical pharmacists as tobacco treatment specialists. This approach leverages the expertise of pharmacists to create sustainable, integrated workflows for delivering smoking cessation care. Recognizing the diverse contexts of clinical settings, the program avoids a one-size-fits-all model, instead collaborating with each clinic to design a customized program tailored to its specific patient population and resources.

Training Components

Pharmacists participating in the ENHANCE-TTS program will receive comprehensive training, including:

• Assessment of tobacco use and dependency.
• Development of individualized treatment plans.
• Counseling strategies to promote successful quit attempts.
• Techniques for helping patients manage cravings and navigate obstacles.
• Specialized modules on establishing clinical practice agreements and optimizing workflow scheduling.

Research Objectives and Expected Outcomes

Primary Study Goals

The study has three primary objectives to evaluate the program’s effectiveness and impact:

1. To determine if providers in participating HIV clinics increase the frequency of smoking status inquiries and the provision of cessation counseling and medication.
2. To assess the program’s acceptability and feasibility from the perspectives of patients, providers, and clinic administrators.
3. To evaluate the success of quit attempts among a subset of patients who receive the pharmacist-led tobacco treatment intervention.

Long-Term Impact and Scalability

The ultimate goal of the ENHANCE-TTS program is to establish a proven, scalable model for delivering effective tobacco cessation treatment to people living with HIV. By reducing smoking rates, the project aims to significantly decrease cancer-related morbidity and mortality in this population. The findings and best practices developed through this study are intended to be disseminated throughout South Carolina and nationally, contributing to broader public health advancements in line with the Sustainable Development Goals.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

This is the primary SDG addressed, as the article focuses entirely on a public health intervention. The ENHANCE-TTS program aims to improve the health of people living with HIV by helping them quit smoking, thereby reducing their risk of lung cancer, cardiovascular disease, and other tobacco-related illnesses. The article states, “People living with HIV who smoke are currently more likely to die from lung cancer than from HIV-related causes,” directly highlighting a critical health and well-being issue.

SDG 10: Reduced Inequalities

The article highlights a health disparity affecting a specific, vulnerable population: people living with HIV who have limited or no insurance. The program is implemented in Ryan White clinics, which “provide HIV/AIDS care to people living with HIV who have limited to no insurance.” By providing targeted, evidence-based tobacco cessation services to this underserved group, the initiative aims to reduce health inequalities and ensure this population has a better opportunity for improved health outcomes.

SDG 17: Partnerships for the Goals

The project described is a multi-stakeholder partnership designed to achieve a common health goal. It involves collaboration between academic researchers (from the Medical University of South Carolina), a cancer center (Hollings Cancer Center), a federal funding agency (National Heart, Lung and Blood Institute), and healthcare providers (pharmacists and clinics). The article notes that researchers “have partnered to train pharmacists in improving tobacco cessation care” and will work with each clinic “in a very collaborative way to design best practices for its setting.”

2. What specific targets under those SDGs can be identified based on the article’s content?

SDG 3: Good Health and Well-being

1. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • The article directly addresses this target by focusing on smoking cessation to prevent deaths from non-communicable diseases like lung cancer and cardiovascular disease. It states, “People living with HIV are more prone to developing various medical conditions, such as cardiovascular disease and pulmonary complications. Added tobacco use exacerbates these ailments.” The program’s goal is to prevent these outcomes.
2. Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.
   • The ENHANCE-TTS program is a direct implementation of tobacco control measures. It focuses on promoting smoking cessation through evidence-based care, including training pharmacists as “tobacco treatment specialists,” developing “individualized treatment plans,” and introducing “counseling strategies to promote the highest likelihood of success for a quit attempt.”
3. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…
   • The program aims to improve “access to tobacco cessation treatments for people living with HIV who smoke.” By implementing this in Ryan White clinics that serve patients with “limited to no insurance,” it directly works towards providing quality, essential health services to a vulnerable population that might otherwise lack access.

SDG 10: Reduced Inequalities

1. Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… economic or other status.
   • The initiative focuses on the health inclusion of a specific group defined by health status (living with HIV) and economic status (limited or no insurance). By providing specialized, tailored healthcare, the program aims to reduce the health outcome gap between this group and the general population.

SDG 17: Partnerships for the Goals

1. Target 17.16: Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships that mobilize and share knowledge, expertise, technology and financial resources…
   • The project is a model of a multi-stakeholder partnership. It combines financial resources from the National Heart, Lung and Blood Institute (“more than $3 million”), the expertise of researchers (Rojewski and Sterba), and the on-the-ground infrastructure of six Ryan White clinics to achieve its goals.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

SDG 3: Good Health and Well-being

1. For Target 3.4:
   • Indicator 3.4.1 (Mortality rate attributed to cardiovascular disease, cancer…): While not directly measured in the study, the long-term goal is to reduce mortality from lung cancer and other tobacco-related diseases in this population. The article’s opening statement about lung cancer being a primary cause of death for this group establishes this as the core problem to be solved.
2. For Target 3.a:
   • Indicator 3.a.1 (Prevalence of current tobacco use): The study’s success is directly tied to this indicator. The article states that the study will “follow up with a subset of patients… to see if their quit attempts were more successful.” A higher rate of successful quits directly translates to a lower prevalence of tobacco use among the target population.

SDG 10: Reduced Inequalities

1. For Target 10.2:
   • Increased access to and utilization of specialized health services: The article implies this will be measured. One of the study’s main goals is to see “whether providers at these HIV clinics will be more likely to ask their patients about their smoking habits and provide counseling and medication.” This measures the successful integration and provision of the service to the target group.

SDG 17: Partnerships for the Goals

1. For Target 17.16:
   • Number of functional multi-stakeholder partnerships and capacity-building initiatives: The article provides concrete numbers for this. The existence of the partnership itself, funded with over $3 million, and its implementation across “six Ryan White clinics” are direct indicators of a functional partnership. The training of pharmacists is a clear capacity-building indicator.

4. Create a table with three columns titled ‘SDGs, Targets and Indicators” to present the findings from analyzing the article.

Source: news-medical.net