7. PROJECT SUMMARY/ABSTRACT We propose M2Q2-HIV [mHealth Messaging to Motivate Quitline use and Quitting among Persons Living with HIV (PLWH) in Vietnam (M2Q2-HIV)], an adaptation of our current computer-tailored smoking cessation intervention in Vietnam. We seek to promote underused government resources for public health (quitline) and nicotine replacement therapy (NRT) among PLWH in a sustainable manner. The intersection of smoking and HIV/AIDS poses a serious public health threat in Vietnam. Vietnam is dealing with these two challenges with parallel rather than integrated plans. Vietnam currently has 431 outpatient clinics for HIV testing, with 188 clinics providing antiretroviral (ARV) treatment, covered by public insurance. Vietnam has setup telephone “quitline” counseling with trained tobacco treatment specialists who also provide NRT. These clinical (HIV) and public health resources (quitlines) are not connected, reducing both programs’ impact. To connect these resources, we will adapt our current intervention for computer-tailored, text-based smoking cessation in Vietnam to be specific to PLWH smoking behavior, for example, by addressing HIV stigma via developing motivational and tailored messages written by PLWH smokers. To further increase message relevance for PLWH smokers, we will add a computer-tailoring innovation: a machine-learning, collective intelligence system. Companies like Amazon use collective intelligence systems to continuously learn and adapt to user feedback (e.g., pages liked, or products purchased), thus, increasing message relevance. We developed the first collective intelligence system for smokers. Our pilot data indicates that the ability to continuously learn may be even more beneficial for smokers who are less ready to quit, such as like PLWH. We will test M2Q2-HIV by conducting a randomized control trial with 600 PLWH smokers in two provinces in Northern Vietnam (26 clinics; 9,877 HIV patients). In Aim 1, we will conduct formative work to prepare the M2Q2-HIV system for PLWH smokers. In Aim 2, we will randomize and follow smokers for six months. Our effectiveness hypothesis will evaluate carbon monoxide (CO) verified, six- month, seven-day point prevalence cessation. Process hypotheses will evaluate self-efficacy, quitline and NRT use, and test our hypothesized model that specific measured processes will partially mediate observed intervention effectiveness. Using qualitative interviews with key stakeholders and PLWH smokers, Aim 3 will support nationwide M2Q2-HIV dissemination assessing acceptability and contextual factors guided by the Practical, Robust Implementation and Sustainability Model (PRISM). This project builds upon a long-standing, successful collaboration between institutions in Vietnam (Ministry of Health, Bach Mai Quitline, Institute of Population Health and Development, Hanoi Medical University) and UMMS. Our team has expertise in smoking cessation, HIV intervention including stigma related to concomitant substance use, and implementation of complex interventions. The Vietnam Ministry of Health is committed to incorporating M2Q2-HIV as a permanent part of the national infrastructure if proven effective.

PROJECT NARRATIVE The intersection of smoking and HIV/AIDS poses a serious public health threat in Vietnam. Vietnam is dealing with these two challenges with parallel rather than integrated plans. Using a computer-tailored texting intervention, in a sustainable manner, we seek to promote use of an underused, available, government-funded resource (quitline) and nicotine replacement therapy (NRT) that the quitline provides, thus, promoting cessation among PLWH.