Table 2 Implementation strategies, adaptations, and justification

Training and clinical decision support (CDS: i.e., coaching guide)

▪ Adapted training for HCPs to facilitate discussions about HIV referent themes during advice and brief counseling.

▪ Adapted training to address specific theory-driven barriers to quitting among PLWH and health impact of smoking among this population and reinforce treatment of waterpipe use.

▪ Adapted a 1-page coaching guide, from the NYC Department of Health to include adapted content from the training to guide the delivery of the 3As during the patient visit.

▪ Dual use of cigarettes and waterpipe use was common.

▪ Coaching guide reinforce training among HCPs with no previous experience delivering TDT and increase self-efficacy motivation and fidelity to 3As+R.

Workflow mapping and redesign

▪ Revised roles and responsibilities to align with a new workflow for each intervention component.

○ 3As.

○ Referral to onsite nurse counselor.

○ Quitline referral.

○ Dispensing NRT onsite.

▪ Increase collective efficacy and promote team care principles: shared goals, defined roles, and responsibilities.

▪ Increase compatibility with routine care and registration process.

▪ Reduce complexity.

▪ OPCs include onsite pharmacies creating an opportunity to normalize the process for offering NRT during patient visits.

Referral system

In partnership with Quitline and staff, changed the standard Vietnam Quitline referral system from reactive to proactive approach: once a referral is received, Quitline initiates calls to patients to engage in counseling.

▪ Studies indicate that a reactive approach is less effective than a proactive approach in reaching patients [20].

▪ Patients and providers confirmed less likely to connect if required to call.

▪ The referral to Quitline created a standard care approach for delegating more intensive counseling to a sustainable resource. Patients were not concerned about confidentiality issues related to Quitline referrals.

TDT documentation and NRT tracking system

Created paper-based screening and TDT documentation system.

Enhance fidelity to the new workflow.