A Peer Navigator Model to Improve Quit Attempts, Quitline Use, and Smoking Cessation Rates among HIV-positive smokers

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ABSTRACT Cigarette smoking is more prevalent in persons living with HIV (PLWH) in the U.S. when compared with the general population and is linked to increased morbidity and mortality in this population. Furthermore, HIV- positive smokers have increased rates of lung and other smoking-related cancers. Because of their high levels of nicotine dependence, low quit rates, and poor adherence to smoking cessation treatments, PLWH may require additional support for quitting compared with the general population of smokers. Peer Navigators (PNs) have been used in HIV care to improve rates of entry into care, adherence with treatment, and retention in care. Linking HIV-positive smokers with a PN who has quit smoking successfully may improve smoking cessation outcomes among PLWH. The primary objectives of this project is to examine the feasibility and acceptability of a peer navigation social support for smoking cessation (PNSS-S) intervention for HIV-positive smokers. We will determine whether enhanced treatment (using a PN to navigate smoking cessation, help obtain medication and treatment, improve adherence to treatment, and provide social support for quitting) will increase quit attempts and smoking cessation rates (measured by 7-day point prevalence) compared with standard care (SC; provider recommendation to quit and quit line referral using the 5A’s). We will also obtain an effect size estimate for the PNSS-S intervention compared to SC. We will test the initial protocol in an open pilot with six HIV-positive smokers and two PNs. Study participants, PNs, and the study nurse will provide ongoing feedback to revise the preliminary protocol. We will then conduct a pilot RCT with 72 HIV-positive smokers to examine the feasibility, acceptability, and initial efficacy of the novel intervention compared to standard care over 24 weeks of follow-up. This study will be the first to examine the feasibility and initial efficacy of a novel intervention using PNs to improve smoking cessation outcomes in PLWH. Given the high prevalence of smoking and the significant morbidity associated with it in PLWH, the development of effective strategies to reduce the risks related to smoking in this group is critical. If determined to be effective, this intervention could be readily disseminated in HIV clinics. Our study will provide key information on the potential benefit of engaging PNs into a smoking cessation program in a population that is highly dependent on nicotine and highly vulnerable to smoking-related morbidity and mortality.