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ABSTRACT
Cigarette smoking is increasingly recognized as an indicator for inferior adherence to antiretroviral therapy (ART) among HIV-positive patients. Given the limited body of work on this issue, we aimed to explore the relations between cigarette smoking, nicotine dependence, and ART adherence in Vietnam. A cross-sectional study of 1050 HIV-positive people was conducted from January to September 2013 in Hanoi (the capital) and Nam Dinh (a rural city). Adherence to ART during the last 30 days was measured by the 100-point visual analog scale (VAS). Smoking history and nicotine dependence (Fagerstrom Test of Nicotine Dependence) were self-reported by participants. Multiple logistic regression was performed to examine the association of current smoking and nicotine dependence with ART nonadherence. Using the established VAS cut point of 95 to indicate adequate adherence, the prevalence of ART nonadherence was 30.9%. Approximately 35.5% of the sample reported current smoking. No association between smoking status and ART nonadherence was found. However, participants with greater nicotine dependence (OR = 1.1, 95%CI = 1.0–1.2 per unit increase) were more likely to be nonadherent. Also, individuals who were female (OR = 1.70, 95%CI = 1.19–2.42), receiving ART in Nam Dinh (OR = 1.6, 95%CI = 1.1–2.4), and currently feeling anxiety (OR = 1.6, 95% CI = 1.2–2.1) had a higher likelihood of ART nonadherence. Additionally, current smokers reporting current pain (OR = 1.9, 95%CI = 1.2–3.1) were more likely to be nonadherent. Conversely, protective factors included living with a spouse/partner (OR = 0.5, 95%CI = 0.3–0.7) and having more than a high school education (OR = 0.4, 95%CI = 0.1–1.0). Given the high prevalence of suboptimal adherence and current smoking among HIV-positive patients, screening for smoking status and nicotine dependence during ART treatment may help to improve patients’ adherence to medication. More efforts should be targeted to women, patients with mental health problems, and ART clinics in rural areas.
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Acknowledgements
We would like to thank the Vietnam Administration of HIV/AIDS Control (VAAC), HIV/AIDS centers, and ART sites at Hanoi and Nam Dinh for their support in conducting this survey.
Notes on contributors
Dr. Nhung Nguyen is a lecturer at Hanoi University of Pharmacy, Vietnam. Her research interests include smoking cessation for HIV-positive people, application of e-Health in improving healthy behaviors, and pharmacoepidemiology.
Dr. Bach Tran is a lecturer in Health Economics at Hanoi Medical University in Vietnam and an assistant professor (adjunct) at Johns Hopkins Bloomberg School of Public Health. His research interests primarily focus on applying decision analytic modeling to inform the development and evaluation of health technologies and policies. He has been intensively working with UN agencies, international organizations, and governments on global health and development issues in South-East Asia. Much of his work centers on determining cost-effective interventions, assessing health technologies, and strengthening health systems, particularly related to HIV/AIDS and emerging diseases in the region.
Dr. Lu-Yu Hwang, Professor of Epidemiology and Center for Infectious Diseases at the University of Texas Health Science Center at Houston School of Public Health has over 30 years’ experience on the research of the epidemiology and control of infectious diseases, especially on hepatitis, HIV, and STI. She has been the co-director of the CITAR (Center for international training and research) program at UTSPH since 2004, to focus on the HIV related research in the developing country, including Vietnam.
Dr. Christine Markham, Associate Professor of Health Promotion and Behavioral Sciences at the University of Texas Health Science Center at Houston School of Public Health has over 20 years’ experience in the development, implementation, evaluation, and dissemination of HIV, STI, and pregnancy prevention and treatment interventions.
Dr. Michael D. Swartz, Assistant Professor of Biostatistics at the University of Texas Health Science Center at Houston School of Public Health has over 10 years’ experience in biostatistical method development and applications. He has developed methods that have been applied in both traditional epidemiology and genetic epidemiology.
Dr. Jennifer I. Vidrine holds the Peggy and Charles Stephen Endowed Chair in Cancer at the Stephenson Cancer Center, University of Oklahoma Health Sciences Center (OUHSC). She is also the Deputy Director for Tobacco Research and the Director of the Oklahoma Tobacco Research Center at the Stephenson Cancer Center, and an Associate Professor in the Department of Family and Preventive Medicine at the OUHSC. Her research program focuses on tobacco use and cessation in underserved populations, and her work has been supported by grants from the National Cancer Institute, the Centers for Disease Control and Prevention, and the Cancer Prevention Research Institute of Texas.
Dr. Huong Phan is the vice chair of Vietnam Administration of HIV/AIDS Control. Her research interests related to health economics, health policy, health services and system, and health technology assessment for HIV/AIDS issues.
Dr. Carl Latkin is a professor at Johns Hopkins Bloomberg School of Public Health. His research interests primarily focus on HIV prevention and care among disadvantaged populations, domestic and international approaches to behavior change, social and personal network analysis, and neighborhood factors and health behaviors.
Dr. Damon J. Vidrine is Program Co-Leader, Cancer Health Disparities at the Stephenson Cancer Center, the University of Oklahoma Health Sciences Center (OUHSC). He also serves as the Associate Director of Research for the Oklahoma Tobacco Research Center at the Stephenson Cancer Center, and is an Associate Professor in the Department of Family and Preventive Medicine at the OUHSC. The primary focus of his research program involves the development and assessment of tobacco cessation treatments for high risk and underserved populations. His work, which has been funded by agencies such as the National Cancer Institute and the Centers for Medicare & Medicaid Services, has involved the delivery of novel smoking cessation interventions to special populations, including community-based low socioeconomic status populations, safety net clinic-based populations, persons living with HIV, and cancer patients.