Introduction:
Strategies are needed to increase implementation of evidence-based guidelines for treating tobacco use in health care systems in low and middle-income countries (LMICs).

Objectives:
To present outcomes from Viet Nam Quits (VQUIT), a cluster randomized controlled trial comparing the effectiveness of two multicomponent implementation strategies for increasing adoption of guideline recommended tobacco dependence treatment (TDT) in commune health centers (CHCs) in Viet Nam.

Methods:
We randomized 26 CHCs into two arms. Arm 1 included training and system changes to promote delivery of the 4As (Ask about tobacco use, Assess readiness to quit, Advise smokers to quit, Assist with brief counseling). Arm 2 included Arm 1 components plus a referral to a trained village health worker (VHW) for 3 sessions of in-person cessation counseling. The primary outcome was provider adoption of the 4As, and in Arm 2 sites, rates of referral to the VHW at the end of the intervention period (12 months).

Results:
Adoption of each of the 4As increased significantly across both study arms (all p<.001). In Arm 2 sites, 41% of smokers were referred to a VHW for additional counseling. Waterpipe users were less likely to receive support for quitting compared with dual and cigarette only smokers. Patients who received VHW counseling plus provider-delivered 4As (Arm 2) were significantly more likely to achieve biochemically confirmed smoking abstinence at 6 months compared to patients who received provider brief counseling alone (Arm 1).

Conclusions:
The study demonstrated the effectiveness of a multicomponent strategy for implementing evidence-based TDT that leveraged the public health care delivery system in Viet Nam to increase access to treatment. Bridging provider delivered screening and brief counseling with opportunities for more in depth VHW-driven treatment may optimize access and outcomes and offers a potentially scalable model for increasing access to treatment in health care systems like Viet Nam.