Behavioral Smoking Cessation Treatment for People Living with HIV/AIDS

描述（由申请人提供）：大约50%至70%的人类免疫缺陷病毒(HIV)/自身免疫缺陷综合征（艾滋病；PLWHA）患者是尼古丁依赖吸烟者，因此吸烟相关发病率和死亡率的风险增加。迫切需要有效的戒烟战略，以减轻吸烟给艾滋病患者带来的健康负担和社会成本。应急管理（CM）治疗在减少其他人群的吸烟方面是有效的，但迄今为止，还没有发表关于在艾滋病患者中使用应急管理戒烟的研究。吸烟的艾滋病感染者将从一个大型城市艾滋病毒/艾滋病治疗诊所招募。所有参与者将接受为期12周的安非他酮治疗。在第一阶段（1-4周），参与者将被随机分配到：1)基于标准护理（SoC）的简短咨询和安非他酮治疗；或2)SoC加上短暂的、高强度的奖励强化（CM），旨在通过提供奖励激励来增强戒断的启动。在第二阶段（第5-12周），我们将使用阶梯式护理模型，根据参与者对第一阶段治疗的反应是否充分，为他们分配量身定制的治疗干预。无反应者将被随机分配到两种8周行为治疗中的一种：1)继续每周进行吸烟咨询和监测；或2)继续咨询加奖励CM。治疗应答者将被随机分配到：1)没有额外的行为治疗（符合SoC）；2) 8周的咨询和监测，加上低强度的奖励CM。吸烟将在治疗前基线、治疗期间以及6个月和12个月的随访点进行评估。治疗期间的结果测量将包括最长时间的持续戒烟和经生物学验证的吸烟减少（可替宁和过期一氧化碳）。长期结果将包括每次随访时7天的吸烟点流行率。我们预测CM患者在每个治疗阶段比非CM患者更能减少吸烟。这项研究具有很高的创新性，因为它首次检查了在艾滋病感染者中使用CM并使用阶梯护理模型戒烟。根据患者治疗早期的结果量身定制戒烟治疗可提高戒烟效果，并最终可降低医疗保健费用并改善艾滋病感染者的整体健康状况。因此，该项目具有很高的公共卫生意义。

DESCRIPTION (provided by applicant): Approximately 50% to 70% of people living with Human Immunodeficiency Virus (HIV)/Autoimmune Deficiency Syndrome (AIDS; PLWHA) are nicotine dependent smokers, and thus at increased risk for smoking-related morbidity and mortality. Effective smoking cessation strategies are urgently needed to reduce both the health burden of smoking on PLWHA and costs to society. Contingency management (CM) treatments are efficacious in reducing cigarette smoking in other populations, but to date there are no published studies on the use of CM for smoking cessation in PLWHA. PLWHA who smoke cigarettes will be recruited from a large urban HIV/AIDS treatment clinic. All participants will receive bupropion treatment for 12 weeks. In Phase 1 (weeks 1-4), participants will be randomly assigned to: 1) Brief counseling and bupropion treatment based on standard of care (SoC); or 2) SoC plus brief, high-magnitude prize reinforcement (CM) designed to enhance initiation of abstinence by providing prize incentives. In Phase 2 (weeks 5-12) we will then use a stepped care model to assign participants to a tailored treatment intervention based on whether they respond adequately to the treatment in Phase 1. Non-responders will be randomly assigned to one of two 8-week behavioral treatments: 1) continued weekly counseling and monitoring of smoking; or 2) continued counseling plus prize CM. Treatment responders will be randomly assigned to: 1) no additional behavioral treatment (consistent with SoC); or 2) 8-weeks of counseling and monitoring, plus low-magnitude prize CM. Smoking will be assessed at pre-treatment baseline, during treatment phases, and at 6- and 12-month follow-up points. Outcome measures during treatment will include longest duration of continuous abstinence and biologically verified reduction in smoking (cotinine and expired carbon monoxide). Long-term outcomes will include 7-day point-prevalence of cigarette smoking at each follow-up. We predict CM patients will reduce cigarette smoking more than non-CM conditions in each treatment phase. This study is highly innovative as it is the first to examine the use of CM and to use a stepped care model for smoking cessation among PLWHA. Tailoring smoking cessation treatment on the basis of patient outcome early in treatment may improve smoking cessation effectiveness, and ultimately may reduce healthcare costs and improve the overall health of PLWHA. Thus this project has a high public health significance.