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

提高针对感染艾滋病毒的退伍军人的戒烟服务的覆盖面和有效性

• 批准号: 10251957
• 负责人: SHERYL L CATZ
• 金额: $ 59.5万
• 依托单位: SEATTLE INST FOR BIOMEDICAL/CLINICAL RES
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-19 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10251957
• 关键词: Abstinence; Address; Adherence; Aging; Awareness; Behavior; Behavioral; Biochemical; CD4 Lymphocyte Count; Car Phone; Caring; Cause of Death; Characteristics; Cigarette; Clinic; Clinical; Clinical Data; Cognitive; Cohort Studies; Communicable Diseases; Community Healthcare; Counseling; Data; Depressed mood; Effectiveness; Enrollment; Exercise; General Population; Geography; Goals; HIV; Health; Health Personnel; Health behavior; Hour; Immunologic Markers; Immunologics; Individual; Infection; Intervention; Knowledge; Malignant Neoplasms; Medical; Modeling; Moods; Motivation; Nicotine Dependence; Outcome; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacotherapy; Pharmacy facility; Practice Guidelines; Prevalence; Process; Provider; Public Health; Randomized; Randomized Controlled Trials; Readiness; Request for Applications; Research; Research Infrastructure; Research Personnel; Risk; Sampling; Self Efficacy; Series; Services; Site; Smoke; Smoker; Smoking; Smoking History; Societies; Stress; Telephone; Testing; Text; Text Messaging; Time; Tobacco Use Cessation; Tobacco use; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Viral; Voice; Wellness Program; Work; antiretroviral therapy; arm; base; care systems; co-infection; comorbid depression; comorbidity; compare effectiveness; data resource; design; evidence base; experience; follow-up; health care delivery; health disparity; health goals; immunological status; improved; indexing; innovation; interest; medication compliance; mortality; mortality risk; motivational enhancement therapy; motivational intervention; nicotine replacement; nicotine use; non-smoker; nutrition; primary outcome; programs; quitline; recruit; remote delivery; response; secondary outcome; skills; smoking abstinence; smoking cessation; smoking prevalence; standard care; stress management; substance use; theories; therapy design; treatment adherence; treatment comparison

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.

项目概要 烟草使用仍然是我们社会中导致死亡和疾病的主要可预防原因，而吸烟 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，以及 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 吸烟者感染艾滋病毒 (SLWH)，导致当前提出申请 (RFA-CA-18-027)。研究 表明 SLWH 在很大程度上不了解吸烟对艾滋病毒特有的有害影响，并且往往缺乏 对自己戒烟能力的动力和信心。出于这些原因，我们开发了健康干预措施 感染艾滋病毒的吸烟者（WISH）。 WISH 以信息-动机-行为技能 (IMB) 模型为基础， 通过手机远程发送（语音和短信）。该计划专为所有 SLWH、 无论他们最初戒烟的动机如何。 WISH 遵循基于证据的尼古丁最佳实践指南 依赖治疗，但其创新之处在于使用了更全面的健康方法。也就是说， 干预措施涉及吸烟和许多其他与个人相关的健康行为（例如 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有吸引力 SLWH，不仅仅是那些准备戒烟的人。对于那些还没有准备好戒烟的人来说，WISH 旨在建立和 增强戒烟的动力和自我效能，同时吸烟者还致力于其他个人健康目标。 一旦准备好戒烟，参与者就会接受基于证据的认知行为咨询和 鼓励使用尼古丁替代疗法（NRT）或其他适当的药物疗法。希望 建立在我们创建增强动机的戒烟干预措施的丰富经验的基础上，并且已经 使用 SLWH 进行试点测试。在此试验中，我们将比较 WISH 与标准护理服务的有效性 通过国家 VA 戒烟热线和 SmokefreeVET 短信计划提供，NCI 支持的烟草 向所有退伍军人提供戒烟服务。双臂的参与者都可以接受电话/短信咨询 可以通过 VA 获得药物治疗。主要结果将在 7 天点进行生化确认 戒烟率以及是否有 24 小时有意戒烟的尝试。次要结果 将包括长期戒烟、每天改变香烟数量、基于结果的中间改变过程 IMB 模型，以及干预范围和实施的指标。与 RFA 目标一致，我们 还将描述合并症并探讨干预措施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 WISH 有效，可以有效减少全国艾滋病病毒感染退伍军人的吸烟率。为了支持这一目标， 计划在第 5 年开展传播工作，与国家 VA 戒烟热线分享 WISH 计划。因为 退伍军人管理局是美国最大的艾滋病毒护理提供者，这项研究有可能对公共卫生产生重大影响。