# Evaluating smoking cessation interventions for PWH in South Africa: Efficacy, implementation, and cost-effectiveness.

> **NIH NIH U01** · JOHNS HOPKINS UNIVERSITY · 2022 · $612,893

## Abstract

PROJECT SUMMARY/ABSTRACT
The purpose of this project is to optimize a smoking cessation program for PWH in South Africa by evaluating
the efficacy, implementation, and cost-effectiveness of evidence-based smoking cessation interventions with
demonstrated success in other low-resource settings. South Africa is home to 7.5 million people with HIV (PWH),
nearly 20% of the global burden. South Africa also has one of the highest annual tuberculosis (TB) incidences
globally (520/100,000) and an increasing burden of cardiovascular disease and chronic obstructive pulmonary
disease (COPD). Smoking is a risk factor for TB, the leading cause of death among PWH. Further, PWH are at
high risk for other smoking-related diseases, including cardiovascular disease and pulmonary comorbidities in
addition to TB. In South Africa, tobacco smoking is prolific; we have found 52% of men and 13% of women with
HIV to be current smokers. South African policy supports screening for smoking and smoking cessation efforts
for PWH; these are included in the South African National antiretroviral therapy (ART) guidelines, the South
African STG-EML, and the South African clinical practice guidelines. Currently, screening for smoking in primary
care settings is low and delivery of smoking cessation interventions even lower. Effective strategies to support
smoking cessation among PWH are necessary to reduce the burden of HIV- and smoking-associated
comorbidities. We have found that social and interpersonal stressors and difficulty managing cravings are
barriers to cessation among PWH who smoke in South Africa. Interventions developed for low-resourced settings
often address these proximal predictors and mediators of cessation, and can be easily adapted for South Africa,
provided they result in meaningful smoking abstinence rates and are feasible to implement. We will evaluate four
evidence-based smoking cessation interventions that address these identified challenges: (1) intensive
behavioral counseling, (2) peer counseling, (3) combination nicotine replacement therapy, and (4) varenicline.
Intervention development is guided by the Multiphase Optimization Treatment Strategy (MOST), a framework
for developing, optimizing, and evaluating interventions with consideration of time and financial resources, as
well as feasibility of implementation and cost. During this optimization phase of MOST, our first aim will evaluate
the main and interaction effects of these interventions among PWH. The second aim will characterize
implementation determinants of delivery of these smoking cessation interventions using the Reach,
Effectiveness, Adoptions, Implementation, Maintenance (RE-AIM) framework to inform scale-up and
sustainability. The third aim will compare the costs, cost-effectiveness, and budget impact of smoking cessation
interventions implemented as a routine program. Results will inform the development of a smoking cessation
treatment package optimized for PWH engaged in the South Afric...

## Key facts

- **NIH application ID:** 10486040
- **Project number:** 5U01CA261626-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** JONATHAN E. GOLUB
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $612,893
- **Award type:** 5
- **Project period:** 2021-09-15 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10486040

## Citation

> US National Institutes of Health, RePORTER application 10486040, Evaluating smoking cessation interventions for PWH in South Africa: Efficacy, implementation, and cost-effectiveness. (5U01CA261626-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10486040. Licensed CC0.

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