Quit For Life (QFL): Smoking Cessation Among Chinese Smokers Living with HIV

项目总结。艾滋病病毒携带者/艾滋病(PLH)患者吸烟是一个主要的预防措施 致病和死亡的原因。中国的成人吸烟率为28.1%，有3.01亿烟民。因为 PLH的吸烟率是普通人群的2-3倍，我们预计超过一半的人 中国的866,000人吸烟。烟草的使用显著影响疾病的进展和结果 艾滋病，并已被确定为导致PLH过早死亡的主要因素。因此， 增加这些吸烟者获得有效戒烟治疗的机会可以减少与烟草相关的发病率 降低死亡率和改善艾滋病毒治疗结果。该项目建议调整和测试 基于理论和量身定制的中国吸烟人群行为戒烟干预(PLHS)。我们 将制定一项干预计划(戒烟终身，QFL)，该计划基于戒烟计划， 在我们之前对香港中国人勃起功能障碍患者的试验中显示了有效性。QFL将会 成为一个以社会认知理论为基础的戒烟计划，专注于设定目标和提高自我效能 作为重要的干预目标和变革的调解人。此外，QFL将针对艾滋病毒和文化 问题，包括关于烟草使用对抗逆转录病毒治疗(ART)治疗结果的作用的提示，使用 移动健康平台(短信)，以加强咨询，并通过激励性访谈提供。这个 具体目标是：i)开发和评估QFL以支持中国PLHS中的戒烟， 以及ii)评估QFL对有效戒烟的初步效果。这项研究将在#年实施 分两个阶段。第一阶段是一项定性研究，将根据PI之前测试的戒烟干预措施量身定做 让它适合中国的PLHS。公共卫生服务计划的焦点小组将探讨如何提高 以前的干预，并纳入与PLHS更相关的问题，并创建QFL。阶段2将 是一项改编的QFL干预的随机对照试验。合资格的公共房屋租户将会前往爱滋病诊所 将接受抗逆转录病毒治疗的传染病医院随机分为干预组和对照组。两组均为 将收到临床医生提供的关于戒烟的简短建议(标准护理，SC)，最长8周免费NRT 和自助手册。在随机分组后，QFL组在8周的时间内将获得100分钟 通过四个不同的联系人(3个面对面和1个电话)提供咨询，两个5分钟的助推器电话 电话，每周2-3条短信；对照组将收到SC增援(SCR)建议(~3分钟) 在一次面对面的接触中。干预后对所有受试者进行为期6个月的跟踪调查。在取得成功的基础上 我们早期的中文研究和我们正在进行的合作，我们建议记录下“QFL”的初步效果 为中国地区公共卫生服务开展量身定做的戒烟干预提供依据。这个项目是 意义重大，因为它利用了艾滋病毒诊所现有医疗保健提供系统的“真实世界”设置，以及， 因此，对人口、卫生系统和政策层面都有很高的潜在影响。

PROJECT SUMMARY. Cigarette smoking among people living with HIV/AIDS (PLH) is a leading preventable cause of morbidity and mortality. With an adult smoking rate of 28.1% China has 301 million smokers. Because smoking rates are 2-3 times higher in PLH than in the general population, we anticipate that more than half of the 866,000 PLH in China smoke tobacco. Tobacco use significantly impacts the progression and outcome of HIV disease, and has been identified as the leading contributor to premature mortality among PLH. Therefore, increasing access to effective cessation treatment for these smokers could reduce tobacco-related morbidity and mortality and improve HIV treatment outcome. This project proposes to adapt and test the effect of a theory-based and tailored behavioral smoking cessation intervention for Chinese PLH who smoke (PLHS). We will develop an intervention program (Quit For Life, QFL), which is based on a smoking cessation program that demonstrated efficacy in our previous trial among Chinese erectile dysfunction patients in Hong Kong. QFL will be a social cognitive theory-based cessation program that focuses on goal setting and increasing self-efficacy as important intervention targets and mediators of change. In addition, QFL will be tailored for HIV and cultural issues, include prompts about the role of tobacco use on anti-retroviral therapy (ART) treatment outcome, use mHealth platform (text messaging) to reinforce counseling and delivered using Motivational Interviewing. The Specific Aims are to: i) develop and evaluate the QFL to support smoking cessation among Chinese PLHS, and ii) assess the preliminary effect of QFL on validated smoking abstinence. The study will be implemented in two phases. Phase1, a qualitative study, will tailor PI’s previously tested smoking cessation intervention to make it appropriate for Chinese PLHS. Focus groups of PLHS will explore how to boost the outcome of the previous intervention and incorporate issues that are more relevant to PLHS, and to create QFL. Phase2 will be a randomized controlled trial of the adapted QFL intervention. Eligible PLHS who will attend the HIV clinic of the Infectious Disease Hospital to receive ART will be randomized to intervention or control group. Both groups will receive clinician delivered brief advice on quit smoking (Standard Care, SC), free NRT for up to 8 weeks and self-help manual. Upon randomization, over the period of 8 weeks, the QFL group will receive 100 minutes of counseling, delivered in four different contacts (3 in-person and 1 over phone), two 5-minute booster phone calls, and 2-3 text messages/week; the control group will receive SC reinforcement (SCR) advice (~3 minutes) in one in-person contact. All subjects will be followed for 6 months post intervention. Building on the success of our earlier studies in Chinese and our ongoing collaboration, we propose to document the initial effect of “QFL” and develop the evidence base of tailored smoking cessation intervention for PLHS in China. This project is significant because it leverages the “real world,” setting of HIV clinic’s existing healthcare delivery system, and, thus, has high potential for population, health system and policy level impact.