Randomized Trial of Automated Video-Assisted Smoking Treatment for People Living with HIV

摘要 现代抗逆转录病毒疗法显著延长了艾滋病患者的预期寿命 艾滋病毒/艾滋病(PLWH)。然而，减少心血管疾病和各种疾病的发生的努力 这一人群中的恶性肿瘤仍然是一个重要的公共卫生优先事项。可以说，最有效的方式是 在PLWH预防这些疾病将是减少吸烟的流行率。尽管 重要的需求，在文献中出现的使用PLWH的戒烟试验相对较少。因此，努力实现以下目标 为携带艾滋病毒的吸烟者开发和评估可持续的、低成本的循证戒烟干预措施 需要的。鉴于移动电话的广泛普及，使用mHealth应用程序的潜力 改善戒烟干预的覆盖面和有效性是有希望的，但缺乏有效性的证据， 特别是在PLWH中。考虑到这些需求，拟议项目的主要目的是 评估针对HIV+吸烟者的全自动智能手机干预。参与者(n=500)将被随机分配 两种治疗条件之一：1)标准治疗(ST，n=250)或自动视频辅助治疗 吸烟治疗(阿瓦斯特，n=250)。ST参与者将以电子方式连接到州政府热线- 提供戒烟治疗，包括积极的电话咨询和尼古丁替代治疗 (NRT)以透皮贴剂的形式。此方法通常称为Ask Adviser Connect(AAC)， 是由我们的团队开发的，并已在许多医疗系统中成功实施。ST将会是 与Avast相比，这是一种完全自动化的治疗提供方法。在Avast条件下，参与者将 接收NRT外加基于智能手机的交互式干预，包括单独定制的音频/视频 和文本内容。Avast的基础规划和开发工作已经完成 由斯蒂芬森癌症中心的mHealth共享资源提供，并由一系列先导性研究得出 (包括在两个拟议的艾滋病毒诊所招聘地点进行的广泛工作)使用测试版 移动应用程序和数据管理系统非常令人鼓舞。这个项目的主要目标是 为了确定Avast在促进长期戒烟(即生化戒烟)方面的表现是否更好 在登记后12个月验证戒酒)，而不是更耗费资源的ST方法。如果功效是 Avast方法建立后，将很容易被各种艾滋病毒诊所和社区采用 并提供了一种将有限的公共卫生资源分配给烟草控制的有效方法 干预措施。主要目的是评估Avast促进戒烟的效果。 PLWH。次要目标包括：1)发掘潜在的调解人和调解人；2)开展经济活动 评估Avast的成本和成本效益的评价。总而言之，迫切需要有效的、 为吸烟的PLWH提供具有成本效益和可持续的戒烟治疗。建议的Avast 干预旨在帮助满足这一需求。

SUMMARY Modern antiretroviral therapy has brought about significantly increased life expectancies for persons living with HIV/AIDS (PLWH). However, the effort to reduce the occurrence of cardiovascular disease and various malignancies in this population remains an important public health priority. Arguably, the most effective way to prevent these diseases in PLWH would be to reduce the prevalence of cigarette smoking. Despite the significant need, relatively few smoking cessation trials with PLWH appear in the literature. Thus, efforts to develop and evaluate sustainable, low cost evidence-based cessation interventions for smokers with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mHealth applications to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among PLWH. With these needs in mind, the overarching purpose of the proposed project is to evaluate a fully automated smartphone intervention for HIV+ smokers. Participants (n=500) will be randomized to one of two treatment conditions: 1) Standard Treatment (ST, n=250) or Automated Video-Assisted Smoking Treatment (AVAST, n=250). ST participants will be electronically connected to state quitline- delivered cessation treatment, consisting of proactive phone counseling plus nicotine replacement therapy (NRT) in the form of transdermal patches. This approach, frequently referred to as Ask Advise Connect (AAC), was developed by our team and has been successfully implemented in numerous health systems. ST will be compared to AVAST, a fully automated treatment delivery approach. In the AVAST condition, participants will receive NRT plus an interactive smartphone-based intervention that comprises individually tailored audio/video and text content. Foundational programming and developmental work for AVAST has already been completed by the Stephenson Cancer Center's mHealth Shared Resource, and results from a series of pilot studies (including extensive work conducted at both proposed HIV clinic recruitment sites) with beta versions of the mobile application and data management system are extremely encouraging. The major goal of this project is to determine if AVAST performs better, in terms of facilitating long-term smoking abstinence (i.e., biochemically verified abstinence 12 months post-enrollment), than the more resource-intensive ST approach. If efficacy is established, the AVAST approach will be readily adoptable by various HIV clinic and community-based organizations, and offer an efficient way to allocate limited public health resources to tobacco control interventions. The primary aim is to evaluate the efficacy of AVAST for facilitating smoking cessation among PLWH. Secondary aims include: 1) exploring potential mediators and moderators, and 2) conducting economic evaluations to assess the cost and cost-effectiveness of AVAST. In sum, there is a critical need for efficacious, cost-effective, and sustainable cessation treatments for PLWH who smoke tobacco. The proposed AVAST intervention has been designed to help fill this need.