Testing the Combination of Behavioral Activation and Problem Solving as a Novel Behavioral Smoking Cessation Intervention for Smokers with HIV in Botswana

测试行为激活和解决问题相结合作为博茨瓦纳艾滋病毒吸烟者的新型戒烟行为干预措施

• 批准号: 10400935
• 负责人: ROBERT GROSS
• 金额: $ 60.76万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400935
• 关键词: AIDS/HIV problem; Abstinence; Address; Adult; Africa; Africa South of the Sahara; African; Anxiety; Behavior; Behavior Therapy; Behavioral; Botswana; Caring; Chronic Obstructive Pulmonary Disease; Counseling; Country; Data; Decentralization; Developing Countries; Epidemic; Evidence based practice; General Population; Goals; HIV; HIV Infections; Health; Income; Individual; Infrastructure; Intervention; Life; Mediating; Mediator of activation protein; Mental Depression; Modeling; Morbidity - disease rate; Motivation; Myocardial Infarction; Nicotine Dependence; Outcome; Pathway interactions; Pattern; Persons; Pharmacotherapy; Pilot Projects; Plant Roots; Population; Problem Solving; Professional counselor; Public Health; Randomized; Research; Rewards; Risk; Role; Sampling; Site; Smoker; Smoking; Smoking Behavior; Smoking Cessation Intervention; Telephone; Testing; Tobacco Dependence; Tobacco Use Cessation; Tobacco smoking behavior; Tobacco use; Tuberculosis; Update; Withdrawal; antiretroviral therapy; base; behavior change; behavioral economics; care delivery; clinical infrastructure; common symptom; comorbidity; cost; depressive symptoms; design; experience; health care availability; health care delivery; high risk; intervention effect; low and middle-income countries; medication compliance; mobile computing; mortality; negative affect; nicotine replacement; novel; pilot test; primary outcome; problem solving therapy; programs; psychological distress; psychological symptom; randomized trial; reduce tobacco use; reinforcer; relapse risk; scale up; skills; smoking cessation; trial comparing; trial design; varenicline; virtual; working group

Project Summary Tobacco smoking is one of the most preventable causes of morbidity and mortality worldwide and has become a growing epidemic in developing countries in Africa. Among HIV+ individuals on antiretroviral therapy, smoking causes more life-year loss than HIV infection. While both behavioral approaches and pharmacotherapy are typically used together in high income countries, pharmacotherapy is largely unavailable in sub-Saharan Africa due to cost. Instead, developing and evaluating behavioral smoking cessation interventions, which could be realistically disseminated is a priority for addressing tobacco use among persons with HIV in countries such as Botswana. Yet, unique aspects of HIV (e.g., high rate of depressive symptoms) and delivery of care in such settings (e.g., decentralized, limited infrastructure) must be considered when designing a behavioral approach in LMICs such as Botswana. Depressive symptoms are common in HIV populations and often comorbid with smoking, and addressing depressive symptoms has been related to better smoking cessation rates. Behavioral activation therapy, rooted in a behavioral economics framework, has been effective at treating depression and preliminary data in the US, including in our group, suggests that it may effectively address smoking as well. Behavioral activation aims to increase engagement in healthy rewarding activities (i.e., substitute reinforcers) by reducing patterns of avoidance, withdrawal, and inactivity, and decrease activities that enhance the rewarding aspects of smoking (i.e., complementary reinforcers). In a parallel way, problem solving approaches have been used with HIV populations for behavior change regarding medication adherence, have also been successful at decreasing depressive symptoms, and are ideally suited for helping smokers select and implement personalized behavioral activation activities to quit smoking. We therefore created the novel Behavioral Activation/Problem Solving for Smoking Cessation (BAPS-SC), culturally adapted it and pilot tested it in Botswana and found it to be feasible and appealing and to have preliminary evidence of efficacy. We will conduct a 1:1 randomized trial comparing a BAPS-SC with standard counseling for smoking cessation in 650 HIV+ smokers in Botswana. We will leverage HIV care sites and deliver the interventions by phone to extend the reach of skilled practitioners. We will also assess whether depressive symptoms moderate the effect of BAPS-SC and test our proposed mediating pathways for the interventions' effects This project will determine whether the novel intervention is superior to standard counseling to establish a new paradigm for LMIC smoking cessation programs. We will also further our understanding of whether depressive symptoms, reinforcers, and problem solving are modifiable mediators of smoking. Leveraging the HIV care infrastructure will facilitate scale-up in sub-Saharan African settings where HIV is common and smoking continues to emerge as a threat to HIV+ individuals' health and survival.

项目摘要 吸烟是全球发病率和死亡率最可预防的原因之一，并且 成为非洲发展中国家的流行病。在抗逆转录病毒的HIV+个体中 治疗，吸烟会导致比艾滋病毒感染更多的终身损失。而两种行为的方法和 药物治疗通常在高收入国家使用，药物疗法在很大程度上不可用 由于成本，在撒哈拉以南非洲。相反，开发和评估行为戒烟 可以实际传播的干预措施是解决人员之间烟草使用的优先事项 在博茨瓦纳等国家有艾滋病毒。然而，艾滋病毒的独特方面（例如，高抑郁症状率） 在这种情况下（例如，分散的，有限的基础设施）在此情况下提供护理 在博茨瓦纳等LMIC中设计一种行为方法。 抑郁症状在艾滋病毒群体中很常见，通常与吸烟合并并解决 抑郁症状与更好的戒烟率有关。行为激活疗法， 植根于行为经济学框架，在治疗抑郁和初步数据方面有效 美国，包括我们小组在内的美国也可能有效地解决了吸烟。行为激活 旨在通过降低模式来增加参与健康的奖励活动（即替代增强剂） 避免，戒断和不活动，并减少活动，以增强吸烟的有意义方面 （即互补的增强剂）。以艾滋病毒的方式使用了解决问题的方法 有关药物依从性行为改变的种群，也成功地减少了 抑郁症状，非常适合帮助吸烟者选择和实施个性化 行为激活活动以戒烟。因此，我们创建了新颖的行为激活/问题 解决戒烟（BAPS-SC），在文化上对其进行了调整，并在博茨瓦纳进行了测试，并发现它是 可行，有吸引力，并具有有效性的初步证据。 我们将进行1：1随机试验，将BAPS-SC与标准咨询进行吸烟的标准咨询 在博茨瓦纳的650 HIV+吸烟者中停止。我们将利用艾滋病毒护理网站并通过 电话以扩展熟练的从业者的范围。我们还将评估抑郁症状是否适中 BAPS-SC的影响并测试我们提出的介导途径对干预措施的影响 该项目将确定新颖的干预措施是否优于标准咨询来建立 LMIC戒烟计划的新范式。我们还将进一步了解是否 抑郁症状，增强剂和解决问题是吸烟的可改变的介体。利用 艾滋病毒护理基础设施将促进撒哈拉以南非洲的艾滋病毒常见和 吸烟继续出现是对艾滋病毒+个人健康和生存的威胁。