Computer-based MI to engage smokers living with HIV in tobacco quitline treatment

描述（由申请人提供）：美国艾滋病毒感染者（PLWH）的吸烟率估计为40-70%，而普通人群的吸烟率已降至20.6%。烟草使用对PLWH有显著的健康影响，在使用高效抗逆转录病毒治疗（HAART）的PLWH跨国队列中，烟草使用占所有死亡人数的近25%。烟草、艾滋病毒和HAART之间的相互作用使吸烟的PLWH比没有艾滋病毒的吸烟者更容易患心血管和肺部疾病，并且还增加了他们患多种艾滋病毒相关疾病的风险。在这种背景下，关于艾滋病患者戒烟干预措施的研究很少发表，也没有人评估过容易传播和纳入标准艾滋病毒治疗的方法。这项研究计划的长期目标是传播一种有效的、简短的基于计算机的干预措施，这种干预措施可以很容易地整合到艾滋病毒治疗环境中，以激励感染艾滋病毒的吸烟者戒烟。本次申请的总体目标是开发这种计算机干预措施，根据最初的试验和反馈对其进行修改，并获得支持干预措施有效性的初步数据。这将通过追求三个具体目标来实现：1)开发并进行初步试点测试（n=16），旨在激励感染艾滋病毒的吸烟者戒烟（CI- METQ）；计算机干预（激励参与戒烟线治疗），并开发和试点（n=4）基于计算机的，时间匹配的营养教育，用于PLWH控制干预（NC），相当于提供戒烟线转诊和8周免费尼古丁贴片，为那些参与戒烟线治疗的人提供，2)进行100名PLWH的初步戒烟随机对照试验，比较CI-METQ与NC，并预测CI-METQ相对于NC将导致更高的准备程度。更高的烟草治疗参与率，更多的戒烟尝试和更高的7天点流行戒断率在1、3和6个月的随访中。在此期间，与健康相关的生活质量也将被检查，并且3)在1、3和6个月的随访中，检查CI-METQ对计算机会话期间关键机制的影响及其与烟草治疗参与和吸烟结果的关联。该研究的创新之处在于：1)以前没有研究针对PLWH的烟草使用实施基于计算机的动机干预；2)本应用中提出的CI-METQ侧重于促进烟草治疗参与，而不是戒烟本身；3)以前没有研究试图将PLWH吸烟者与免费戒烟热线联系起来，这是一种有效且容易获得的资源。CI-METQ将有可能在艾滋病毒治疗环境中广泛推广，如果有效，将对减少与吸烟有关的发病率和死亡率以及推进有关使用简短的计算机干预措施改变艾滋病毒感染者健康风险行为的科学知识产生重大的总体影响。

DESCRIPTION (provided by applicant): The prevalence of cigarette smoking among people living with HIV (PLWH) in the U.S. is estimated at 40-70%, as the smoking rate in the general population has declined to 20.6%. Tobacco use has significant health consequences for PLWH, accounting for nearly 25% of all deaths in a multinational cohort of PLWH who used highly active antiretroviral therapy (HAART). Interactions among tobacco, the HIV virus, and HAART render PLWH who smoke even more susceptible than smokers without HIV to cardiovascular and lung diseases, and also increases their risk for a multitude of HIV-related illnesses. Against this backdrop, very little research on smoking cessation interventions for PLWH has been published, and none has evaluated approaches that could be easily disseminated and integrated into standard HIV care. The long-term goal of this program of research is to disseminate an effective, brief computer-based intervention that can be readily integrated into HIV treatment settings to motivate tobacco quitline use among smokers living with HIV. The overall objective of this application is to develop this computer intervention, modify it based on initial piloting and feedback, and obtain preliminary data supporting the efficacy of the intervention. This will be accomplished by pursuing three specific aims: 1) to develop and conduct preliminary pilot testing (n=16) of a brief, computer- based intervention intended to motivate tobacco quitline use among cigarette smokers living with HIV (CI- METQ; Computer Intervention to Motivate Engagement in Tobacco Quitline treatment) and to develop and pilot (n=4) a computer-based, time matched nutrition education for PLWH control intervention (NC) equated for the offer of a tobacco quitline referral and 8 weeks of free nicotine patch for those who engage in quitline treatment, 2) to conduct a preliminary smoking cessation RCT with 100 PLWH, comparing CI-METQ vs. NC, with predictions that CI-METQ relative to NC will result in increased readiness, higher rates of tobacco treatment engagement, more quit smoking attempts and higher rates of 7-day point prevalence abstinence rates at 1-, 3- and 6-month follow-ups. Health-related quality of life over this period will also be examined, and 3) to examine CI-METQ's effects on key mechanisms during the computer session and their associations with tobacco treatment engagement and smoking outcomes at 1-, 3- and 6-month follow-ups. The research proposed is innovative in that: 1) no previous studies have implemented a computer-based motivational intervention targeting tobacco use in PLWH, 2) the CI-METQ proposed in this application is focused on promoting tobacco treatment engagement rather than smoking cessation, per se, and 3) no previous studies have attempted to link PLWH smokers with free tobacco quitlines, an efficacious and readily available resource. The CI-METQ will have potential for broad reach within HIV treatment settings and if effective, will have significant overall impact in reducing smoking-related morbidity and mortality and in advancing scientific knowledge regarding the use of brief, computer interventions to change health risk behaviors in PLWH.