Quit For Life (QFL): Smoking Cessation Among Chinese Smokers Living with HIV

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PROJECT SUMMARY. Cigarette smoking among people living with HIV/AIDS (PLH) is a leading preventable cause of morbidity and mortality. With an adult smoking rate of 28.1% China has 301 million smokers. Because smoking rates are 2-3 times higher in PLH than in the general population, we anticipate that more than half of the 866,000 PLH in China smoke tobacco. Tobacco use significantly impacts the progression and outcome of HIV disease, and has been identified as the leading contributor to premature mortality among PLH. Therefore, increasing access to effective cessation treatment for these smokers could reduce tobacco-related morbidity and mortality and improve HIV treatment outcome. This project proposes to adapt and test the effect of a theory-based and tailored behavioral smoking cessation intervention for Chinese PLH who smoke (PLHS). We will develop an intervention program (Quit For Life, QFL), which is based on a smoking cessation program that demonstrated efficacy in our previous trial among Chinese erectile dysfunction patients in Hong Kong. QFL will be a social cognitive theory-based cessation program that focuses on goal setting and increasing self-efficacy as important intervention targets and mediators of change. In addition, QFL will be tailored for HIV and cultural issues, include prompts about the role of tobacco use on anti-retroviral therapy (ART) treatment outcome, use mHealth platform (text messaging) to reinforce counseling and delivered using Motivational Interviewing. The Specific Aims are to: i) develop and evaluate the QFL to support smoking cessation among Chinese PLHS, and ii) assess the preliminary effect of QFL on validated smoking abstinence. The study will be implemented in two phases. Phase1, a qualitative study, will tailor PI’s previously tested smoking cessation intervention to make it appropriate for Chinese PLHS. Focus groups of PLHS will explore how to boost the outcome of the previous intervention and incorporate issues that are more relevant to PLHS, and to create QFL. Phase2 will be a randomized controlled trial of the adapted QFL intervention. Eligible PLHS who will attend the HIV clinic of the Infectious Disease Hospital to receive ART will be randomized to intervention or control group. Both groups will receive clinician delivered brief advice on quit smoking (Standard Care, SC), free NRT for up to 8 weeks and self-help manual. Upon randomization, over the period of 8 weeks, the QFL group will receive 100 minutes of counseling, delivered in four different contacts (3 in-person and 1 over phone), two 5-minute booster phone calls, and 2-3 text messages/week; the control group will receive SC reinforcement (SCR) advice (~3 minutes) in one in-person contact. All subjects will be followed for 6 months post intervention. Building on the success of our earlier studies in Chinese and our ongoing collaboration, we propose to document the initial effect of “QFL” and develop the evidence base of tailored smoking cessation intervention for PLHS in China. This project is significant because it leverages the “real world,” setting of HIV clinic’s existing healthcare delivery system, and, thus, has high potential for population, health system and policy level impact.