AIDS and Behavior

, Volume 18, Issue 7, pp 1381–1389 | Cite as

Tobacco Use Among Adults Initiating Treatment for HIV Infection in Rural Uganda

  • Gina R. Kruse
  • David R. Bangsberg
  • Judith A. Hahn
  • Jessica E. Haberer
  • Peter W. Hunt
  • Conrad Muzoora
  • John P. Bennett
  • Jeffrey N. Martin
  • Nancy A. Rigotti
Original Paper


We conducted a longitudinal study of tobacco use among adults initiating antiretroviral therapy (ART) in Mbarara, Uganda where 11 % of men and 3 % of women use tobacco according to the 2011 Demographic and Health Survey. In a prospective cohort, self-reported tobacco use was assessed before starting ART and reassessed every 3–4 months. Plasma cotinine, a nicotine metabolite, was measured in a subset of adults pre-ART to verify self-report. Among 496 subjects, 50 (10 %) reported current tobacco use (20 % of men, 6 % of women). Most (53 %) adults with elevated cotinine levels (>15 ng/mL) reported no tobacco use. By 6 months after ART initiation, 33 % of tobacco users had quit (95 % CI 20–46 %). By 5 years, 64 % quit (95 % CI 47–77 %). Self-reported tobacco use among rural Ugandans starting ART was twice as common as among the local background population and use may be underreported. ART initiation could be an opportunity for tobacco cessation interventions.


Tobacco use Smoking cessation Socioeconomic status Resource-limited setting Antiretroviral treatment initiation 



We would like to acknowledge the contributions of Dr. Martin A. Javors. Dr. Javors conducted the cotinine assays for the subset that was tested and provided helpful feedback on the reporting of the cotinine results. The Ugandan AIDS Rural Treatment Outcomes study was funded by U.S. National Institutes of Health (NIH) R01 MH-054907, K23 MH-079713, K23 MH-079713-03S1, and P30 AI-027763. Dr. Kruse was supported by Grant T32HP12706-03-00 from the Health Resources and Services Administration for the Harvard General Medicine Fellowship and the Ryoichi Sasakawa Fellowship Fund. Dr. Bangsberg was funded by NIH Grant K24 MH87227. Dr. Haberer was funded by NIH Grant K23 087228. The funders of these grants had no role in study design, conduct, data analysis, interpretation, or manuscript preparation, review, or approval. An earlier version of this work was presented as a poster at the Society for Research on Nicotine and Tobacco 19th Annual meeting on March 16, 2013 in Boston, MA

Conflict of interest

The authors declare no conflicts of interest.


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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Gina R. Kruse
    • 1
    • 2
    • 3
  • David R. Bangsberg
    • 4
    • 5
    • 6
  • Judith A. Hahn
    • 7
    • 8
  • Jessica E. Haberer
    • 1
    • 4
  • Peter W. Hunt
    • 7
  • Conrad Muzoora
    • 5
  • John P. Bennett
    • 8
  • Jeffrey N. Martin
    • 8
  • Nancy A. Rigotti
    • 1
    • 2
    • 3
  1. 1.Division of General Medicine, Department of MedicineMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.Tobacco Research and Treatment Center, Department of MedicineMassachusetts General HospitalBostonUSA
  4. 4.Center for Global HealthMassachusetts General HospitalBostonUSA
  5. 5.Mbarara University of Science and TechnologyMbararaUganda
  6. 6.Ragon Institute of MGH, MIT and Harvard UniversityBostonUSA
  7. 7.Department of Medicine, San Francisco General HospitalUniversity of California San FranciscoSan FranciscoUSA
  8. 8.Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoUSA

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