Improving the Reach and Effectiveness of Smoking Cessation Services Targeted to Veterans Living with HIV

项目摘要 烟草使用仍然是我们社会中主要的可预防的死亡和疾病原因， 艾滋病毒感染者的感染率高得不成比例。NCI，尼古丁依赖研究人员， 艾滋病毒临床医生都呼吁进行研究，以评估有针对性和量身定制的戒烟计划， 艾滋病毒感染者吸烟者（SLWH），导致目前的申请（RFA-CA-18-027）。研究 表明SLWH在很大程度上没有意识到吸烟对HIV的特定有害影响， 他们戒烟的动力和信心。出于这些原因，我们开发了健康干预， 吸烟者感染艾滋病毒（WISH）。WISH基于信息-动机-行为技能（IMB）模型， 通过移动的电话远程传送（语音和文本消息）。该计划是专为所有SLWH， 不管他们最初的戒烟动机是什么WISH遵循基于证据的尼古丁最佳实践指南 它是一个创新的治疗依赖，但在使用更全面的健康方法。也就是 干预既针对吸烟，也针对一些其他个人相关的健康行为（如 治疗依从性、压力/情绪、营养、其他物质使用等），使其与所有人相关并吸引所有人 SLWH，不仅仅是那些准备戒烟的人。对于那些还没有准备好退出，WISH的目的是建立和 增强戒烟的动力和自我效能，同时吸烟者也致力于其他个人健康目标。 一旦准备戒烟，参与者接受循证认知行为咨询， 鼓励使用尼古丁替代疗法（NRT）或其他适当的药物治疗。希望 建立在我们丰富的经验，创造动机增强戒烟干预，并已 用SLWH进行了试点测试。在本试验中，我们将比较WISH和标准护理服务的有效性 通过国家退伍军人事务部戒烟热线和无烟VET短信计划提供，NCI支持的烟草 为所有退伍军人提供服务。两组的参与者都可以接受电话/短信咨询， 通过VA获得药物治疗。主要结局将在7天时间点进行生化确认 吸烟率、戒烟率和任何24小时内有意戒烟尝试的存在。次要结局 将包括长期戒烟，每天香烟的变化，基于中间变化过程的结果 以及干预范围和实施的衡量标准。与RFA的目标一致，我们 还将描述合并症，并探讨干预对免疫状态和死亡风险标志物的影响 利用退伍军人老龄化队列研究（VACS）提供的优秀临床数据资源。如果 有效，WISH可以有意义地减少全国艾滋病毒+退伍军人的吸烟。为了支持这一目标， 计划在第5年开展传播工作，与全国退伍军人事务部戒烟热线分享WISH方案。因为 弗吉尼亚州是美国最大的艾滋病护理提供者，这项研究有可能对公共卫生产生重大影响。

PROJECT SUMMARY Tobacco use remains the leading preventable cause of death and illness in our society, and smoking rates are disproportionately high among people living with HIV. NCI, nicotine dependence researchers, and HIV clinicians have all called for research to evaluate targeted and tailored smoking cessation programs for smokers living with HIV (SLWH), leading to the current request for applications (RFA-CA-18-027). Research suggests SLWH are largely unaware of the HIV-specific deleterious effects of smoking and often lack motivation and confidence in their ability to quit. For these reasons, we developed the Wellness Intervention for Smokers with HIV (WISH). WISH is grounded in the Information-Motivation-Behavioral Skills (IMB) Model and delivered remotely by mobile phone (voice and text message). The program is designed for all SLWH, regardless of their initial motivation to quit. WISH follows evidence-based, best practice guidelines for nicotine dependence treatment, but is innovative in its use of a more comprehensive wellness approach. That is, the intervention addresses both smoking and a number of other personally relevant health behaviors (such as treatment adherence, stress/mood, nutrition, other substance use, etc.), making it relevant and engaging to all SLWH, not just those ready to stop smoking. For those not yet ready to quit, WISH is designed to build and strengthen motivation and self-efficacy for quitting, while smokers also work on other personal health goals. Once ready to quit smoking, participants receive evidence-based cognitive-behavioral counseling and encouragement to use nicotine replacement therapy (NRT) or other appropriate pharmacotherapy. WISH builds on our extensive experience creating motivationally-enhanced cessation interventions and has been pilot tested with SLWH. In this trial, we will compare the effectiveness of WISH to standard care services offered through the National VA Quitline and the SmokefreeVET texting program, NCI-supported tobacco cessation services available to all Veterans. Participants in both arms can receive phone/ text counseling and have access to pharmacotherapy through VA. Primary outcomes will be biochemically confirmed 7-day point prevalence smoking abstinence and presence of any 24-hour intentional quit attempts. Secondary outcomes will include prolonged abstinence, change in cigarettes per day, intermediate change process outcomes based on the IMB model, as well as metrics of intervention reach and implementation. Consistent with RFA goals, we will also describe comorbidities and explore intervention impact on markers of immune status and mortality risk using the outstanding clinical data resources available through the Veterans Aging Cohort Study (VACS). If effective, WISH could meaningfully reduce smoking among HIV+ Veterans nationwide. To support this goal, dissemination efforts are planned in Year 5 to share the WISH program with the National VA Quitline. Because VA is the largest U.S. provider of HIV care, this research has the potential for significant public health impact.