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

项目摘要 吸烟是全世界最可预防的发病和死亡原因之一， 在非洲的发展中国家日益流行。在接受抗逆转录病毒治疗的艾滋病毒阳性者中 在治疗中，吸烟比艾滋病毒感染造成更多的生命年损失。虽然行为方法和 在高收入国家，药物治疗通常是一起使用的， 在撒哈拉以南非洲，由于成本。相反，开发和评估行为戒烟 可以切实传播的干预措施是解决人们吸烟问题的优先事项 在博茨瓦纳等国家感染艾滋病毒。然而，艾滋病毒的独特方面（例如，抑郁症状发生率高） 以及在这样的环境中的护理递送（例如，分散的、有限的基础设施）， 在博茨瓦纳等中低收入国家设计行为方法。 抑郁症状在艾滋病毒感染人群中很常见，并且经常与吸烟共病， 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，在治疗抑郁症和初步数据， 美国，包括我们集团中的美国，建议它也可以有效地解决吸烟问题。行为激活 旨在增加对健康奖励活动的参与（即，替代燃料）， 避免、戒断和不活动，并减少增强吸烟奖励方面的活动 (i.e.,互补的互补物）。与此同时，解决问题的方法也被用于艾滋病毒 关于药物依从性的行为改变的人群，也成功地减少了 抑郁症状，并非常适合帮助吸烟者选择和实施个性化 行为激活活动戒烟。因此，我们创造了新的行为激活/问题 解决戒烟问题（BAPS-SC），对它进行文化调整，并在博茨瓦纳进行试点测试，发现它 具有可行性和吸引力，并有初步的疗效证据。 我们将进行一项1：1的随机试验，比较BAPS-SC与标准吸烟咨询 博茨瓦纳650名艾滋病毒阳性吸烟者戒烟。我们将利用艾滋病毒护理站点，通过以下方式提供干预措施： 电话，以扩大熟练的从业人员的范围。我们还将评估抑郁症状是否中度 BAPS-SC的效果，并测试我们提出的干预效果的介导途径 这个项目将确定新的干预是否上级于标准咨询，以建立一个 LMIC戒烟计划的新范例。我们还将进一步了解， 抑郁症状、抑郁症和解决问题的能力是吸烟的可调节介质。借力 艾滋病毒护理基础设施将有助于在艾滋病毒常见的撒哈拉以南非洲地区扩大规模， 吸烟继续成为对艾滋病毒阳性者健康和生存的威胁。

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.