A trial of Positively Smoke Free group therapy for HIV-infected smokers

描述(申请人提供)：美国有110万艾滋病毒携带者(PLWH)，其中60%吸烟，75%有戒烟兴趣。目前几乎没有人获得旨在满足他们特定需求和关切的戒烟干预措施。吸烟是PLWH中24%的死亡原因，而在非艾滋病定义的恶性肿瘤中，吸烟是30%的原因。它正在推动这一高度脆弱的人群中心脏事件和肺癌的惊人上升。无法获得经过验证的、有效的、符合文化的戒烟服务，这代表着第一批人的健康差距。PLWH吸烟者群体的心理社会状况表明，实现高戒烟率将是一个巨大的挑战，其特征是精神共病、药物和酒精使用的高比率以及社会支持的低水平。积极无烟(PSF)是一个密集的，多疗程，团体戒烟计划，专门为PLWH吸烟者开发的。PSF的初步研究取得了令人振奋的结果。这项建议的目的是(1)通过比较450名PLWH吸烟者中随机接受PSF和标准治疗的受试者的6个月生化确认戒烟率来进行PSF的明确疗效研究，(2)确定与成功戒烟相关的社会行为调节因素和中介因素，以及(3)完成PSF的仔细成本分析，以便估计每次戒烟相关计划参与的增量成本。如果PSF被证明是有效的，它将为PLWH吸烟者建立一个新的治疗选择。确定项目成功的主持人和调解人将有助于深入了解干预的行动模式，并有助于指导未来制定更多的治疗策略。最后，成本分析将提供有关方案传播和执行的可行性的关键信息。

DESCRIPTION (provided by applicant): There are 1.1 million persons living with HIV (PLWH) in the US, 60% of them smoke cigarettes, and 75% of these are interested in quitting. Almost none are currently accessing smoking cessation interventions designed to meet their specific needs and concerns. Cigarette smoking is responsible for 24% of deaths among PLWH, and 30% of non-AIDS defining malignancies. It is driving the alarming rise in cardiac events and lung cancers in this highly vulnerable population. The lack of access to proven, effective, culturally appropriate tobacco cessation services represents a health disparity of the first order. The psychosocial profile of the PLWH-smoker community, characterized by high rates of psychiatric comorbidity, drug and alcohol use, and low levels of social support, suggests that achieving high cessation rates will be a great challenge. Positively Smoke Free (PSF) is an intensive, multisession, group cessation program specifically developed for PLWH smokers. A pilot study of PSF yielded promising results. This proposal aims (1) to perform a definitive efficacy study of PSF by comparing 6-month biochemically confirmed abstinence rates in subjects randomized to PSF vs. standard care in a cohort of 450 PLWH smokers, (2) to determine the sociobehavioral moderators and mediators associated with successful cessation, and (3) to complete a careful cost analysis of PSF in order to estimate the incremental cost per quit associated program participation. If PSF is proven to be effective it will establish a new treatment option for PLWH smokers. Determination of moderators and mediators of program success will provide insight into the mode of action of the intervention and will help guide the development of additional treatment strategies in the future. Finally, the cost analyses will provide critical information abut the feasibility of program dissemination and implementation.