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Smoking
Systematic identification and referral of smokers attending HIV ambulatory care highlights the failure of current service provision in an at-risk population
  1. James Brown1,
  2. Christianna Kyriacou1,
  3. Elisha Pickett1,
  4. Kelly Edwards1,
  5. Hemal Joshi1,
  6. Nafeesah Stewart1,
  7. Andrew Melville1,
  8. Margaret Johnson2,
  9. Jan Flint1,
  10. Angela Bartley1,
  11. Alison Rodger3 and
  12. Marc Lipman4
  1. 1Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
  2. 2Respiratory and HIV Medicine, Royal Free London NHS Foundation Trust, London, UK
  3. 3Institute for Global Health, University College London Medical School, London, UK
  4. 4UCL Respiratory, University College London, London, UK
  1. Correspondence to Dr Marc Lipman; marclipman{at}nhs.net

Abstract

Introduction People living with HIV (PLWH) are more likely to smoke than the general population and are at greater risk of smoking-related illness. Healthcare services need to address this burden of preventable disease.

Methods We evaluated the impact of a brief intervention that asked service users about smoking when they attended for ambulatory HIV care in London, UK, and offered referral to smoking cessation.

Results Overall, 1548 HIV-positive individuals were asked about their smoking status over a 12-month period. Of this group, 385 (25%) reported that they were current smokers, 372 (97%) were offered referral to smoking cessation services and 154 (40%) accepted this. We established an outcome of referral for 114 (74%) individuals. A total of 36 (10% of smokers) attended stop smoking clinics and 16 (4%) individuals were recorded as having quit smoking.

Discussion The simple intervention of asking PLWH about tobacco smoking and offering referral to smoking cessation services rapidly identified current smokers, 40% of whom accepted referral to smoking cessation services. This highlights the importance of promoting behaviour and lifestyle changes with every contact with health services. However, a large proportion of those referred were either not seen in local services or the outcome of referral could not be ascertained. If the risk of smoking-related morbidity among PLWH is to be reduced, more sustainable referral pathways and ways of improving uptake of smoking cessation services must be developed.

  • Tobacco and the lung

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2018-000395

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    Footnotes

    • Contributors JB and ML conceived of the study and led the data analysis. CK, EP, KE and HJ completed data collection. NS, AM, EP and JF collated and analysed data regarding referrals to smoking cessation clinic. AB, JF, AR, ML and JB conducted data analyses. All the authors were involved in the preparation of the manuscript for submission.

    • Funding This work was partly supported by funding from a Gilead Fellowship Programme grant.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This manuscript describes the results of a quality improvement project undertaken within clinical services for which no additional data were collected beyond that collected for clinical purposes. This, therefore, was exempt from the need for research ethics service approval.

    • Provenance and peer review Not commissioned; externally peer reviewed.