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

描述（由申请人提供）：美国有110万艾滋病毒感染者（PLWH），其中60%吸烟，其中75%有戒烟的兴趣。目前，几乎没有人能够获得旨在满足其特定需求和关切的戒烟干预措施。吸烟导致24%的艾滋病患者死亡，30%的非艾滋病恶性肿瘤。在这一高度脆弱的人群中，心脏病和肺癌的发病率正以惊人的速度上升。缺乏获得经证实的、有效的、在文化上适当的戒烟服务的机会是首要的健康差距。plwh吸烟者社区的社会心理状况，其特点是精神合并症、药物和酒精使用率高，社会支持水平低，这表明实现高戒烟率将是一个巨大的挑战。积极无烟（PSF）是一项专门为PLWH吸烟者开发的密集、多时段、群体戒烟计划。对PSF的初步研究取得了可喜的结果。本研究的目的是：(1)通过比较随机分配到PSF和标准治疗组的450名PLWH吸烟者的6个月生化证实的戒烟率，对PSF进行明确的疗效研究；(2)确定与成功戒烟相关的社会行为调节因子和调节因子；(3)完成对PSF的仔细成本分析，以估计每次戒烟相关项目的增量成本。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。确定项目成功的调节者和调解者将提供对干预行动模式的洞察，并将有助于指导未来其他治疗策略的发展。最后，成本分析将提供有关方案传播和实施可行性的关键信息。

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.