# Testing the Combination of Behavioral Activation and Problem Solving as a Novel Behavioral Smoking Cessation Intervention for Smokers with HIV in Botswana

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2024 · $143,970

## Abstract

Project Summary
 Tobacco smoking is one of the most preventable causes of morbidity and mortality worldwide and has
become a growing epidemic in developing countries in Africa. Among HIV+ individuals on antiretroviral
therapy, smoking causes more life-year loss than HIV infection. While both behavioral approaches and
pharmacotherapy are typically used together in high income countries, pharmacotherapy is largely unavailable
in sub-Saharan Africa due to cost. Instead, developing and evaluating behavioral smoking cessation
interventions, which could be realistically disseminated is a priority for addressing tobacco use among persons
with HIV in countries such as Botswana. Yet, unique aspects of HIV (e.g., high rate of depressive symptoms)
and delivery of care in such settings (e.g., decentralized, limited infrastructure) must be considered when
designing a behavioral approach in LMICs such as Botswana.
 Depressive symptoms are common in HIV populations and often comorbid with smoking, and addressing
depressive symptoms has been related to better smoking cessation rates. Behavioral activation therapy,
rooted in a behavioral economics framework, has been effective at treating depression and preliminary data in
the US, including in our group, suggests that it may effectively address smoking as well. Behavioral activation
aims to increase engagement in healthy rewarding activities (i.e., substitute reinforcers) by reducing patterns of
avoidance, withdrawal, and inactivity, and decrease activities that enhance the rewarding aspects of smoking
(i.e., complementary reinforcers). In a parallel way, problem solving approaches have been used with HIV
populations for behavior change regarding medication adherence, have also been successful at decreasing
depressive symptoms, and are ideally suited for helping smokers select and implement personalized
behavioral activation activities to quit smoking. We therefore created the novel Behavioral Activation/Problem
Solving for Smoking Cessation (BAPS-SC), culturally adapted it and pilot tested it in Botswana and found it to
be feasible and appealing and to have preliminary evidence of efficacy.
 We will conduct a 1:1 randomized trial comparing a BAPS-SC with standard counseling for smoking
cessation in 650 HIV+ smokers in Botswana. We will leverage HIV care sites and deliver the interventions by
phone to extend the reach of skilled practitioners. We will also assess whether depressive symptoms moderate
the effect of BAPS-SC and test our proposed mediating pathways for the interventions' effects
 This project will determine whether the novel intervention is superior to standard counseling to establish a
new paradigm for LMIC smoking cessation programs. We will also further our understanding of whether
depressive symptoms, reinforcers, and problem solving are modifiable mediators of smoking. Leveraging the
HIV care infrastructure will facilitate scale-up in sub-Saharan African settings where HIV is common and
smoking ...

## Key facts

- **NIH application ID:** 10978303
- **Project number:** 3R01DA045604-05S1
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** ROBERT GROSS
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $143,970
- **Award type:** 3
- **Project period:** 2020-06-01 → 2026-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10978303

## Citation

> US National Institutes of Health, RePORTER application 10978303, Testing the Combination of Behavioral Activation and Problem Solving as a Novel Behavioral Smoking Cessation Intervention for Smokers with HIV in Botswana (3R01DA045604-05S1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10978303. Licensed CC0.

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