Development of an Integrated mHealth App-Based Intervention to Support Smoking Cessation in People Living with HIV

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PROJECT SUMMARY / ABSTRACT The advent of highly active antiretroviral therapy (HAART) has greatly reduced mortality in persons living with HIV (PLWH), to the point where now lifestyle-related factors pose greater threat to long-term survival than HIV, chief among them smoking. Although interest in quitting smoking is high amongst PLWH, the prevalence of smoking among PLWH remains more than twice as high as that in the general population. Encouragingly, there have been successes in leveraging HIV primary care settings to engage PLWH smokers in smoking cessation efforts. Scaling up and expanding on this success has been difficult, however, as past evidence has indicated that interventions with more sessions produced stronger effects. High intensity face-to-face interventions are not readily scalable. Mobile health (mHealth) approaches, however, can provide continuous and as-needed support over longer periods of time, reducing the need for in-person treatment while providing prolonged support. To this end, and building on our previous work, we propose to develop an mHealth intervention that integrates (1) the “Smiling instead of Smoking” (SiS) app, a conceptually-grounded, iteratively developed smoking cessation smartphone app (M-PI Hoeppner), (2) a successful face-to- face smoking cessation treatment for SLH, called QUIT (M-PI O'Cleirigh), and (3) Life Steps, our efficacious brief intervention to promote adaptive engagement in HIV care. This integrated treatment will be informed and specified through the completion of the treatment development aims. We anticipate that it will combine initial face-to-face, SLH-focused treatment with SLH-adapted, real-time, temporally tailored smartphone app support over 8 weeks. Aim 1 is to build the integrated mHealth app intervention (SiS-H) based on feedback derived in user-centered design research with smokers living with HIV (SLH), consultation with HIV smoking cessation scientists and clinicians, and collaboration with our software development partner. Aim 2 is to conduct a proof-of-concept randomized controlled trial to test the feasibility, acceptability, and preliminary efficacy of SiS-H, while tracking HIV-specific outcomes. The app to be adapted is Version 3 of the SiS app, which is based on social cognitive theory, and implements clinical practice guidelines within a positive psychology framework. The proposed integrated treatment will emphasize protecting the experience of positive emotions among SLH as they navigate quitting smoking, and support increased self-efficacy through the complementing skills-based training of the QUIT and Life Steps components. The proposed project advances the critically important public health goal of making smoking cessation support more readily available to PLWH smokers. More pragmatically, data from this project could inform the design of a larger R01-funded RCT and the necessary regulatory strategy to advance towards approval of SiS-H as a prescription treatment that could well be sustainable in HIV primary care and other community health clinical settings.