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 吸烟是全世界发病率和死亡率最可预防的原因之一，并已 在非洲发展中国家成为一种日益严重的流行病。HIV+人群中服用抗逆转录病毒药物的人数 在治疗方面，吸烟比感染艾滋病毒造成的寿命损失更多。虽然行为方法和 在高收入国家，药物治疗通常一起使用，药物治疗在很大程度上是不可用的 在撒哈拉以南非洲地区，由于成本的原因。相反，开发和评估行为戒烟 可实际传播的干预措施是解决人中烟草使用问题的优先事项 博茨瓦纳等国的艾滋病毒携带者。然而，艾滋病毒的独特方面(例如，抑郁症状的高比率) 在以下情况下，必须考虑在这种环境(例如，分散的、有限的基础设施)中提供护理 在博茨瓦纳等低收入国家设计一种行为方法。 抑郁症状在艾滋病毒人群中很常见，通常与吸烟和 抑郁症状与较高的戒烟率有关。行为激活疗法， 植根于行为经济学框架，在治疗抑郁症方面一直有效，初步数据显示 美国，包括我们小组的成员，建议它也可以有效地解决吸烟问题。行为激活 旨在通过减少以下模式来增加对健康奖励活动的参与度(即替代增强剂) 避免、戒烟、不活动和减少增加吸烟有益方面的活动 (即，补充增强剂)。以类似的方式，解决问题的方法也被用于艾滋病毒 改变服药依从性行为的人群也成功地减少了 抑郁症状，非常适合帮助吸烟者选择和实施个性化 戒烟的行为激活活动。因此，我们创作了小说《行为激活/问题》 解决戒烟问题(BAPS-SC)，对其进行文化调整，并在博茨瓦纳进行试点测试，发现它 要可行和有吸引力，并有初步的有效性证据。 我们将进行1：1随机试验，比较BAPS-SC和标准吸烟咨询 博茨瓦纳650名HIV+吸烟者戒烟。我们将利用艾滋病毒护理网站，并通过 电话，以扩大熟练从业者的触角。我们还将评估抑郁症状是否中度 BAPS-SC的效果和我们提出的干预效果的中介途径的检验 该项目将确定新的干预措施是否优于标准咨询，以建立 LMIC戒烟计划的新范例。我们还将进一步了解是否 抑郁症状、增强剂和解决问题都是吸烟的可调节媒介。利用 艾滋病毒护理基础设施将促进在撒哈拉以南非洲地区扩大规模，那里的艾滋病毒很常见， 吸烟继续成为对艾滋病毒携带者的健康和生存的威胁。

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.