Change in self-reported tobacco cessation support practices among HIV providers in Kisumu, Kenya: a pre-post evaluation of a web-based training programme nested within the IN-ToUCH cluster randomised trial.

Introduction: 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' (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. Methods: This pre-post 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-May 2023) and received access to self-paced web-based training modules on tobacco cessation aligned with Kenya's national 5As framework (Ask, Advise, Assess, Assist, Arrange). A follow-up survey was administered 3 months later. Outcomes were compared between baseline and follow-up using McNemar's 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. Results: 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<0.001); advising clients to quit (93.5% vs 70.2%; p<0.001); assessing readiness to quit (89.6% vs 67.2%; p<0.001); assisting clients to quit (90.1% vs 56.7%; p<0.001) and arranging follow-up (82.1% vs 36.3%; p<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)). Conclusions: 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.