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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

Abstract

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.

Keywords

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

Notes

Acknowledgments

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.

References

  1. 1.
    World Health Organization. WHO Report on the Global Tobacco Epidemic, 2011: Warning about the dangers of tobacco. In: Geneva, Switzerland; 2011. http://whqlibdoc.who.int/publications/2011/9789240687813_eng.pdf. Accessed October 24, 2013.
  2. 2.
    Crothers K, Griffith TA, McGinnis KA, Rodriguez-Barradas MC, Leaf DA, Weissman S, et al. The impact of cigarette smoking on mortality, quality of life, and comorbid illness among HIV-positive veterans. J Gen Intern Med. 2005;20:1142–5.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Palella FJ, Baker RK, Buchacz K, Chmiel JS, Tedaldi EM, Novak RM, et al. Increased mortality among publicly insured participants in the HIV outpatient study despite HAART treatment. AIDS. 2011;25:1865–76.PubMedCrossRefGoogle Scholar
  4. 4.
    Vidrine DJ, Arduino RC, Lazev AB, Gritz ER. A randomized trial of a proactive cellular telephone intervention for smokers living with HIV/AIDS. AIDS. 2006;20:253–60.PubMedCrossRefGoogle Scholar
  5. 5.
    Wallace JM, Rao AV, Glassroth J, Hansen NI, Rosen MJ, Arakaki C, et al. Respiratory illness in persons with human immunodeficiency virus infection. The pulmonary complications of HIV infection study group. Am Rev Respir Dis. 1993;148:1523–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Royce RA, Winkelstein W. HIV infection, cigarette smoking and CD4+ T-lymphocyte counts: preliminary results from the San Francisco men’s health study. AIDS. 1990;4:327–33.PubMedCrossRefGoogle Scholar
  7. 7.
    Niaura R, Shadel WG, Morrow K, Tashima K, Flanigan T, Abrams DB. Human immunodeficiency virus infection, AIDS, and smoking cessation: the time is now. Clin Infect Dis. 2000;31:808–12.PubMedCrossRefGoogle Scholar
  8. 8.
    Greenwood GL, Paul JP, Pollack LM, Binson D, Catania JA, Chang J, et al. Tobacco use and cessation among a household-based sample of US urban men who have sex with men. Am J Public Health. 2005;95:145–51.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Stall RD, Greenwood GL, Acree M, Paul J, Coates TJ. Cigarette smoking among gay and bisexual men. Am J Public Health. 1999;89:1875–8.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Reynolds NR. Cigarette smoking and HIV: more evidence for action. AIDS Educ Prev. 2009;21:106–21.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Lifson AR, Neuhaus J, Arribas JR, van den Berg-Wolf M, Labriola AM, Read TR, et al. Smoking-related health risks among persons with HIV in the strategies for management of antiretroviral therapy clinical trial. Am J Public Health. 2010;100:1896–903.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Marshall MM, McCormack MC, Kirk GD. Effect of cigarette smoking on HIV acquisition, progression, and mortality. AIDS Educ Prev. 2009;21:28–39.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Helleberg M, Afzal S, Kronborg G, Larsen CS, Pedersen G, Pedersen C, et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis 2012Google Scholar
  14. 14.
    Townsend L, Flisher AJ, Gilreath T, King G. A systematic literature review of tobacco use among adults 15 years and older in sub-Saharan Africa. Drug Alcohol Depend. 2006;84:14–27.PubMedCrossRefGoogle Scholar
  15. 15.
    Pampel F. Tobacco use in sub-Sahara Africa: estimates from the demographic health surveys. Soc Sci Med. 2008;66:1772–83.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Desalu OO, Oluboyo PO, Olokoba AB, Adekoya AO, Danburam A, Salawu FK, et al. Prevalence and determinants of tobacco smoking among HIV patients in North Eastern Nigeria. Afr J Med Med Sci. 2009;38:103–8.PubMedGoogle Scholar
  17. 17.
    Iliyasu Z, Gajida AU, Abubakar IS, Shittu O, Babashani M, Aliyu MH. Patterns and predictors of cigarette smoking among HIV-infected patients in northern Nigeria. Int J STD AIDS. 2012;23:849–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Martinson NA, Golub JE, Chaisson R, et al. TB risk and smoking in HIV-infected adults: a prospective cohort. Paper #998. In: 15th Conference on Retroviruses and Opportunistic Infections 2008. Boston, MA, USA; 2008. http://www.retroconference.org/2008/PDFs/998.pdf. Accessed January 14, 2013.
  19. 19.
    Munyati SS, Redzo N, Dauya E, Matambo R, Makamure B, Bandason T, et al. Human immunodeficiency virus, smoking and self-rated health in Harare, Zimbabwe. Int J Tuberc Lung Dis. 2006;10:1279–85.PubMedGoogle Scholar
  20. 20.
    Yeager DS, Krosnick JA. The validity of self-reported nicotine product use in the 2001–2008 national health and nutrition examination survey. Med Care. 2010;48:1128–32.PubMedCrossRefGoogle Scholar
  21. 21.
    Caraballo RS, Giovino GA, Pechacek TF, Mowery PD. Factors associated with discrepancies between self-reports on cigarette smoking and measured serum cotinine levels among persons aged 17 years or older: third national health and nutrition examination survey, 1988–1994. Am J Epidemiol. 2001;153:807–14.PubMedCrossRefGoogle Scholar
  22. 22.
    Wong SL, Shields M, Leatherdale S, Malaison E, Hammond D. Assessment of validity of self-reported smoking status. Health Rep. 2012;23:47–53.PubMedGoogle Scholar
  23. 23.
    Mamary EM, Bahrs D, Martinez S. Cigarette smoking and the desire to quit among individuals living with HIV. AIDS Patient Care STDS. 2002;16:39–42.PubMedCrossRefGoogle Scholar
  24. 24.
    Tesoriero JM, Gieryic SM, Carrascal A, Lavigne HE. Smoking among HIV positive New Yorkers: prevalence, frequency, and opportunities for cessation. AIDS Behav. 2010;14:824–35.PubMedCrossRefGoogle Scholar
  25. 25.
    Weiser SD, Tsai AC, Gupta R, Frongillo EA, Kawuma A, Senkungu J, et al. Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting. AIDS. 2012;26:67–75.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Uganda Bureau of Statistics and ICF International. Uganda Demographic and Health Survey 2011. In. Kampala, Uganda and Calverton, Maryland; 2012. http://www.ubos.org/onlinefiles/uploads/ubos/UDHS/UDHS2011.pdf. Accessed October 24, 2013.
  27. 27.
    Kaida A, Matthews LT, Kanters S, Kabakyenga J, Muzoora C, Mocello AR, et al. Incidence and predictors of pregnancy among a cohort of HIV-positive women initiating antiretroviral therapy in Mbarara, Uganda. PLoS One. 2013;8:e63411.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Wu AW, Rubin HR, Mathews WC, Ware JE, Brysk LT, Hardy WD, et al. A health status questionnaire using 30 items from the Medical Outcomes Study. Preliminary validation in persons with early HIV infection. Med Care. 1991;29:786–98.PubMedCrossRefGoogle Scholar
  29. 29.
    Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med 1998;158:1789–1795Google Scholar
  30. 30.
    Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31:1208–17.PubMedCrossRefGoogle Scholar
  31. 31.
    Hahn JA, Bwana MB, Javors MA, Martin JN, Emenyonu NI, Bangsberg DR. Biomarker testing to estimate under-reported heavy alcohol consumption by persons with HIV initiating ART in Uganda. AIDS Behav. 2010;14:1265–8.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Jarvis MJ, Tunstall-Pedoe H, Feyerabend C, Vesey C, Saloojee Y. Comparison of tests used to distinguish smokers from nonsmokers. Am J Public Health. 1987;77:1435–8.PubMedCentralPubMedCrossRefGoogle Scholar
  33. 33.
    SRNT Subcommittee on Biochemical Verification. Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002;4:149–59.CrossRefGoogle Scholar
  34. 34.
    Benowitz NL, Bernert JT, Caraballo RS, Holiday DB, Wang J. Optimal serum cotinine levels for distinguishing cigarette smokers and nonsmokers within different racial/ethnic groups in the United States between 1999 and 2004. Am J Epidemiol. 2009;169:236–48.PubMedCrossRefGoogle Scholar
  35. 35.
    Musoke F. The Uganda Global Youth Tobacco Survey Report (2008)—Tobacco Control Policy Implications. In: Brazzaville; 2008. http://www.who.int/tobacco/surveillance/Uganda__Brazzaville08.pdf. Accessed October 31, 2013.
  36. 36.
    Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005;162:199–200.PubMedCrossRefGoogle Scholar
  37. 37.
    Westreich D, Cole SR. Invited commentary: positivity in practice. Am. J. Epidemiol. 2010,171:674–677; discussion 678–681.Google Scholar
  38. 38.
    Vijayaraghavan M, Penko J, Vittinghoff E, Bangsberg DR, Miaskowski C, Kushel MB. Smoking behaviors in a community-based cohort of HIV-infected indigent adults. AIDS Behav 2013.Google Scholar
  39. 39.
    Velicer WF, Prochaska JO. A comparison of four self-report smoking cessation outcome measures. Addict Behav. 2004;29:51–60.PubMedCrossRefGoogle Scholar
  40. 40.
    Hughes JR, Carpenter MJ, Naud S. Do point prevalence and prolonged abstinence measures produce similar results in smoking cessation studies? A systematic review. Nicotine Tob Res. 2010;12:756–62.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Satagopan JM, Ben-Porat L, Berwick M, Robson M, Kutler D, Auerbach AD. A note on competing risks in survival data analysis. Br J Cancer. 2004;91:1229–35.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Gray RJ. A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat. 1988;16:1141–54.CrossRefGoogle Scholar
  43. 43.
    Marshall MM, Kirk GD, Caporaso NE, McCormack MC, Merlo CA, Hague JC, et al. Tobacco use and nicotine dependence among HIV-infected and uninfected injection drug users. Addict Behav. 2011;36:61–7.PubMedCentralPubMedCrossRefGoogle Scholar
  44. 44.
    Triant VA, Lee H, Hadigan C, Grinspoon SK. Increased acute myocardial infarction rates and cardiovascular risk factors among patients with human immunodeficiency virus disease. J Clin Endocrinol Metab. 2007;92:2506–12.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Krishnan S, Schouten JT, Jacobson DL, Benson CA, Collier AC, Koletar SL, et al. Incidence of non-AIDS-defining cancer in antiretroviral treatment-naïve subjects after antiretroviral treatment initiation: an ACTG longitudinal linked randomized trials analysis. Oncology. 2011;80:42–9.PubMedCentralPubMedCrossRefGoogle Scholar
  46. 46.
    Shapiro AE, Tshabangu N, Golub JE, Martinson NA. Intention to quit smoking among human immunodeficiency virus infected adults in Johannesburg, South Africa. Int J Tuberc Lung Dis. 2011;15:140–2.PubMedGoogle Scholar

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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