Using Multiphase Optimization Strategy (MOST) to Optimize a Cost-effective, Sustainable and Scalable Smoking Cessation Package for Smokers in HIV Clinical Care

使用多阶段优化策略 (MOST) 为 HIV 临床护理中的吸烟者优化具有成本效益、可持续且可扩展的戒烟方案

• 批准号: 10548592
• 负责人: Jennifer Cantrell
• 金额: $ 66.84万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10548592
• 关键词: AIDS/HIV problem; Abstinence; Acute; Address; Administrator; Affect; Biochemical; Caring; Cause of Death; Cessation of life; Clinical; Collaborations; Competence; Complex; Consolidated Framework for Implementation Research; Cost Analysis; Cost Measures; Counseling; Data; Decision Analysis; Disease; Economics; Effectiveness; Effectiveness of Interventions; Evaluation; Face; General Population; Goals; HIV; Health; Health Personnel; Healthcare Systems; Hospitals; Individual; Internet; Intervention; Intervention Trial; Interview; Knowledge; Life; Longitudinal Studies; Measures; Medical; Methods; Motivation; Municipalities; National Cancer Institute; New York City; Nicotine Withdrawal; Outcome; Persons; Pharmacotherapy; Population; Population Heterogeneity; Prevalence; Process; Proctor framework; Professional counselor; Public Health; Readiness; Research; Resources; Risk; Services; Smoker; Smoking; Smoking Cessation Intervention; Social support; Structure; Surveys; Testing; Text Messaging; Time; Tobacco; Tobacco Use Cessation; Withdrawal; barrier to care; base; cigarette smoking; clinical care; comorbidity; cost; cost effective; cost effectiveness; effective therapy; effectiveness evaluation; evidence base; implementation intervention; implementation outcomes; implementation process; improved; innovation; interest; intervention cost; motivational enhancement therapy; multi-component intervention; multiphase optimization strategy; nicotine replacement; non-smoker; patient-level barriers; peer coaching; premature; process evaluation; programs; risk perception; skills; smoking cessation; social; social stigma; theories; varenicline

Project Summary The adverse health impact of cigarette smoking on persons living with HIV is profound and effective treatments for long-term abstinence remain elusive. There is an acute need for interventions that address patient barriers to quitting and clinical barriers to effectively treating a broad heterogeneous population of smokers living with HIV (SLWH). This study’s long-term goal is to improve clinical outcomes among SLWH by providing optimized smoking cessation interventions in HIV clinical care. This proposal will use the Multiphase Optimization STrategy (MOST) to test four intervention components aimed at barriers to quitting among SLWH, with the objective of selecting the set that constitutes a cost-effective, sustainable, scalable smoking cessation package for HIV clinical care. Components include: Motivational Interviewing (Off/On); Peer Mentoring (Off/On); Text-messaging (Off/On); Varenicline or Combination Nicotine Replacement Therapy (Off/On). These components have shown promise in research but are under-utilized to help SLWH quit and have not been tested in an optimization trial. The proposed MOST factorial optimization trial is a highly efficient method for estimating the main effect contribution of each intervention component and all interactions between components. This approach addresses weaknesses in prior studies, which are not able to assess the contribution of individual components of multicomponent interventions. The proposal will also include a rigorous evaluation of the implementation process and theory-driven assessment of barriers to and facilitators of intervention implementation, sustainability and scalability in HIV clinical care. Aims include: (1) Assess the effectiveness of four smoking cessation intervention components on long-term abstinence among SLWH by conducting a highly efficient factorial optimization trial (i.e., MOST) with 500 SLWH in HIV clinical care. (2) Assess costs and the implementation process, including factors that affect the potential for sustainability and scalability of cessation treatment in HIV care settings serving SLWH. Guided by Proctor’s Implementation Outcomes Framework and the Consolidated Framework for Implementation Research, we will collect mixed methods data on reach, fidelity, acceptability and appropriateness among SLWH, stakeholders and study interventionists. (3) Identify the optimized intervention by conducting an innovative multi-criteria decision analysis to select the subset of the four components that achieves the highest level of cost-effectiveness and is both scalable and sustainable in HIV clinical care. Working in collaboration with New York City Health and Hospitals (H+H), the largest municipal public healthcare system in the U.S., and a team with unparalleled expertise in intervention optimization, smoking cessation and HIV/AIDS, the proposed study responds directly to the National Cancer Institute’s (NCI) call for smoking research that “optimizes intervention effectiveness, implementation and sustainability.” The optimized intervention will have a significant public health impact and add to scientific knowledge by providing a clear basis for further improvement of cessation interventions for SLWH in future research.

项目摘要 吸烟对艾滋病毒感染者健康的不利影响是深刻和有效的治疗方法 长期禁欲的可能性仍然很小迫切需要解决患者障碍的干预措施 戒烟和临床障碍，以有效地治疗广泛的异质性吸烟人群， 艾滋病毒（SLWH）。本研究的长期目标是通过提供优化的治疗方案来改善SLWH的临床结局。 艾滋病毒临床护理中的戒烟干预措施。本提案将使用多阶段优化策略 （社会变革管理计划）测试四个干预组成部分，旨在消除SLWH中的戒烟障碍，目的是 选择一套构成一个具有成本效益的，可持续的，可扩展的艾滋病毒戒烟包 临床护理组件包括：动机面试（关/开）;同伴指导（关/开）;短信 (Off/开）;伐尼克兰或联合尼古丁替代疗法（关/开）。这些组件显示 在研究中有希望，但在帮助SLWH戒烟方面没有得到充分利用，并且尚未在优化试验中进行测试。 提出的MOST析因优化试验是一种高效的估计主效应的方法 每个干预组成部分的贡献和组成部分之间的所有互动。这种方法解决 以前的研究中的弱点，无法评估个别成分的贡献， 多元干预。该提案还将包括对执行过程的严格评估 和理论驱动的评估的障碍和促进因素的干预措施的实施，可持续性和 艾滋病临床护理的可扩展性。目的包括：（1）评估四种戒烟干预措施的效果 通过进行高效析因优化试验， (i.e.,在艾滋病毒临床护理方面，有500名SLWH。(2)评估成本和实施过程，包括 影响艾滋病毒护理机构中戒烟治疗的可持续性和可扩展性的因素 SLWH。在普罗克特的执行成果框架和 实施研究，我们将收集混合方法数据的范围，保真度，可接受性和 SLWH、利益相关者和研究干预者之间的适当性。(3)确定优化的干预措施 通过进行创新的多标准决策分析，选择四个组成部分的子集， 实现了最高水平的成本效益，在艾滋病毒临床护理中既可扩展又可持续。工作 与纽约市卫生和医院（H+H）合作，这是最大的市政公共医疗保健系统 在美国，和一个在干预优化、戒烟和艾滋病毒/艾滋病方面拥有无与伦比的专业知识的团队， 这项研究直接响应了美国国家癌症研究所（NCI）对吸烟研究的呼吁， “优化干预的有效性、实施和可持续性”。优化的干预措施将具有 对公众健康产生重大影响，并通过为进一步改进提供明确基础而增加科学知识 在未来的研究中对SLWH进行戒烟干预。