{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:58:19Z","timestamp":1781269099866,"version":"3.54.1"},"reference-count":31,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"unspecified","delay-in-days":72,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute at the National Institutes of Health","doi-asserted-by":"crossref","award":["NIH-U01CA261620"],"award-info":[{"award-number":["NIH-U01CA261620"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,4,27]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>HIV care providers are in frequent contact with their patients and are well placed to provide tobacco cessation support. Yet they rarely do so in Kenya, despite National Guidelines calling for cessation interventions to be integrated into HIV care. Increasing healthcare providers\u2019 (HCPs) knowledge in tobacco cessation interventions could improve quit rates and contribute to better health outcomes. We evaluated whether a web-based training programme improved HIV HCPs' self-reported delivery of tobacco cessation support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This pre\u2013post evaluation was conducted within 19 HIV clinics participating in the Integration of Tobacco Use Cessation for People with HIV in Health Care cluster randomised trial in Kisumu, Kenya. HCPs completed a baseline survey (April\u2013May 2023) and received access to self-paced web-based training modules on tobacco cessation aligned with Kenya\u2019s national 5As framework (Ask, Advise, Assess, Assist, Arrange). A follow-up survey was administered 3\u2009months later. Outcomes were compared between baseline and follow-up using McNemar\u2019s test for paired binary data. Associations between provider characteristics and reported cessation practices were examined using multivariable mixed-effects logistic regression models adjusted for repeated measures and clustering at the clinic level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 246 HCPs who completed the baseline survey, 201 (81.7%) completed the 3-month follow-up survey. Participants had a mean age of 35.6 years (SD 8.9), 67% were female and the mean duration of HIV care practice was 6.9 years (SD 4.4). At follow-up, HCPs were significantly more likely to report always\/usually delivering each of the 5As compared with baseline: asking about tobacco use (92.0% vs 68.2%, p&lt;0.001); advising clients to quit (93.5% vs 70.2%; p&lt;0.001); assessing readiness to quit (89.6% vs 67.2%; p&lt;0.001); assisting clients to quit (90.1% vs 56.7%; p&lt;0.001) and arranging follow-up (82.1% vs 36.3%; p&lt;0.001). Providers were also significantly more likely to recommend the national Quitline, refer clients to other cessation services and recommend cessation medications after training. In multivariate models, certificate-level training was associated with higher odds of consistent provision of all 5 components of the 5As framework (OR 2.0 (95% CI 1.3 to 3.3)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Access to self-paced web-based training was associated with increased self-reported delivery of tobacco cessation support by HIV HCPs. Scalable digital training programmes may support integration of tobacco cessation into routine HIV care in Kenya and similar settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-003544","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T12:05:19Z","timestamp":1781265919000},"page":"e003544","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Change in self-reported tobacco cessation support practices among HIV providers in Kisumu, Kenya: a pre\u2013post evaluation of a web-based training programme nested within the IN-ToUCH cluster randomised trial"],"prefix":"10.1136","volume":"4","clinical-trial-number":[{"clinical-trial-number":"nct05351606","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1273-2316","authenticated-orcid":false,"given":"Yvonne A","family":"Olando","sequence":"first","affiliation":[{"name":"National Authority for the Campaign Against Alcohol and Drug Abuse, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael M","family":"Onyango","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Nairobi County, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A","family":"Bukusi","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Nairobi County, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joelle","family":"Brown","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"},{"name":"Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linnet","family":"Ongeri","sequence":"additional","affiliation":[{"name":"Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Starley B","family":"Shade","sequence":"additional","affiliation":[{"name":"Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Vijayaraghavan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca A","family":"Odhiambo","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Nairobi County, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cirilus Ogollah","family":"Osongo","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Nairobi County, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig R","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Magati","sequence":"additional","affiliation":[{"name":"Development Economist, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Kwena","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Nairobi County, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greshon","family":"Rota","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Nairobi County, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Purba","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine A","family":"Osula","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Kenya Medical Research Institute, Kisumu, Nairobi County, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry John","family":"Ouner","sequence":"additional","affiliation":[{"name":"Family Healthcare Nursing, University of California San Francisco, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stella S","family":"Bialous","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences, School of Nursing, University of California San Francisco, San Francisco, California, USA"},{"name":"University of California San Francisco Center for Tobacco Control Research & Education, San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"2026061205050950000_4.2.e003544.1","unstructured":"Who global report on trends in prevalence of tobacco use 2000-2025. 4th edn. Geneva: WHO, 2021."},{"key":"2026061205050950000_4.2.e003544.2","unstructured":"U.S. Department of Health and Human Services . The health consequences of smoking\u201450 years of progress: A report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014."},{"key":"2026061205050950000_4.2.e003544.3","doi-asserted-by":"publisher","DOI":"10.1080\/13550280701620747"},{"key":"2026061205050950000_4.2.e003544.4","doi-asserted-by":"crossref","first-page":"e578","DOI":"10.1016\/S2214-109X(17)30170-5","article-title":"Tobacco use among people living with HIV: analysis of data from Demographic and Health Surveys from 28 low-income and middle-income countries","volume":"5","author":"Mdege","year":"2017","journal-title":"Lancet Glob Health"},{"key":"2026061205050950000_4.2.e003544.5","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis933"},{"key":"2026061205050950000_4.2.e003544.6","doi-asserted-by":"crossref","first-page":"1858","DOI":"10.1007\/s10461-024-04279-1","article-title":"Factors Influencing Tobacco Smoking and Cessation Among People Living with HIV: A Systematic Review and Meta-analysis","volume":"28","author":"Hoang","year":"2024","journal-title":"AIDS Behav"},{"key":"2026061205050950000_4.2.e003544.7","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph19073859","article-title":"Tobacco Use among HIV-Positive and HIV-Negative Women and Men in Zambia-Demographic and Health Survey, 2018","volume":"19","author":"Kress","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"2026061205050950000_4.2.e003544.8","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12875-023-01981-2","article-title":"Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies","volume":"24","author":"Tildy","year":"2023","journal-title":"BMC Prim Care"},{"key":"2026061205050950000_4.2.e003544.9","unstructured":"TADSAS . National survey on the status of tobacco use in Kenya. Ministry of Health, Kenya National Bureau of Statistics [KNBS], & NACADA, 2022."},{"key":"2026061205050950000_4.2.e003544.10","unstructured":"NACADA . Status of drugs and substance use among university students in Kenya. Republic of Kenya & NACADA; 2024."},{"key":"2026061205050950000_4.2.e003544.11","unstructured":"WHO Guidelines for Implementation of Framework Convention on Tobacco Control, Article 14. WHO, 2019."},{"key":"2026061205050950000_4.2.e003544.12","unstructured":"Ministry of Health Kenya- Tobacco Control Unit. National Guidelines for Tobacco Dependence, Treatment and Cessation, MOH 2017."},{"key":"2026061205050950000_4.2.e003544.13","unstructured":"Kenya Essential Medicines List 2019. Kenya: Ministry of Health,"},{"key":"2026061205050950000_4.2.e003544.14","unstructured":"Tobacco control data initiative. Tobacco cessation in Kenya, 2023. 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