Effectiveness of a smoking cessation algorithm integrated into HIV primary care

吸烟仍然是美国可预防的死亡和残疾的主要原因。而吸烟 在一般人群中的个体中显著下降，它聚集在 易受伤害的个人，如艾滋病毒/艾滋病感染者（PLWH），他们的吸烟率和 由此造成的合并症比率仍然很高。艾滋病毒治疗的医学进步已经导致了大量的 PLWH中预期寿命的增加，因此PLWH吸烟者现在比以往任何时候都更加 与烟草有关的疾病和死亡的风险增加。事实上，从事治疗的PLWH吸烟者 现在吸烟比艾滋病更能延长寿命。虽然艾滋病毒感染者吸烟者从事艾滋病毒护理， 通常每4-6个月看一次医疗服务提供者，戒烟治疗和转诊通常不是戒烟治疗的一部分。 常规艾滋病护理虽然94%的艾滋病毒治疗提供者表示，他们愿意提供吸烟， 然而，在向病人提供戒烟服务方面，很少有人接受过如何提供戒烟服务的培训。 有七种一线药物可用于戒烟，开发算法以帮助 提供者在选择最合适的药物治疗是一个重要的，但未经检验的战略，以增加 戒烟在PLWH。我们的试点工作为这一方法和我们的干预提供了初步支持 导致禁欲增加，药物治疗的使用增加，24小时戒烟尝试增加， 与接受标准护理的人相比，戒烟动机增强。说这一点是为 进行混合疗效/有效性试验，比较算法治疗与处方成本抵消 和退出线转诊（AT）到增强治疗即治疗（仅退出线转诊; eTAU）组。六百 PLWH吸烟者将在伯明翰的亚拉巴马大学、华盛顿大学和 芬威健康艾滋病毒诊所，并将随机接受AT或eTAU。所有AT吸烟者将接受活性 治疗12周，无论是否有戒烟的动机或意图。eTAU吸烟者将被转介 戒烟热线服务和艾滋病毒提供者可以选择把吸烟作为标准护理的一部分。参与者将 研究持续12个月。主要结果将是点患病率戒烟在6 个月其他与吸烟相关的结果包括24小时戒烟尝试和减少吸烟 每天都抽烟。关注的有效性结果包括成本效益分析、吸烟人数 药物治疗处方的书面，以及提供者的知识和信心的变化，以治疗吸烟。如果 如果成功，这种算法可以提供一个重要的工具，可以很容易地维持和使用 通过电子病历或传送到移动终端，以帮助医疗保健专业人员 为艾滋病毒携带者和艾滋病患者的吸烟者提供戒烟治疗。

Smoking remains the leading cause of preventable death and disability in the United States. Whereas smoking has declined significantly among individuals in the general population, it is clustered in populations of vulnerable individuals such as people living with HIV/AIDS (PLWH) in whom smoking prevalence rates and resulting comorbidity rates remain high. Medical advances in the treatment of HIV have resulted in substantial increases in life expectancy among PLWH and as a consequence PLWH smokers are now, more than ever, at heightened risk for tobacco-related illnesses and death. In fact, PLWH smokers engaged in treatment lose more years of life due to smoking now than to HIV disease. Although PLWH smokers engaged in HIV care typically see a medical provider every 4-6 months, smoking cessation treatment and referral is often not part of routine HIV care. While 94% of HIV treatment providers indicated that they would be willing to provide smoking cessation services to their patients, few have received training in how to provide smoking cessation services. With seven first line pharmacotherapies available for smoking cessation, development of algorithms to assist providers in selecting the most appropriate pharmacotherapy is an important but untested strategy to increase smoking cessation in PLWH. Our pilot work has provided initial support for this approach and our intervention has resulted in increased abstinence, higher use of pharmacotherapy, increased 24-hour quit attempts, and enhanced in motivation to quit, compared to those receiving standard of care. The purpose of this proposal is to conduct a mixed efficacy/effectiveness trial comparing an algorithm treatment with prescription cost off sets and quit line referral (AT) to an enhanced Treatment as Usual (quit line referral only; eTAU) group. Six hundred PLWH smokers will be recruited at the University of Alabama at Birmingham, University of Washington, and Fenway Health HIV clinics and will be randomized to receive AT or eTAU. All AT smokers will receive active treatment for twelve weeks regardless of stated motivation or intention to quit. eTAU smokers will be referred to quit line services and HIV providers may elect to treat smoking as part of standard of care. Participants will remain in the study for 12 months. The primary outcome will be point prevalence smoking abstinence at 6 months. Other smoking-related outcomes of interest include 24-hour quit attempts and reduction in cigarettes smoked per day. Effectiveness outcomes of interest include cost effectiveness analyses, number of smoking pharmacotherapy prescriptions written, and change in provider knowledge and confidence to treat smoking. If successful, this algorithm could provide an important tool that could be easily sustained and available for use through the electronic medical record or transferred to a mobile device to aid health care professionals in providing smoking cessation treatment to PLWH smokers.