Behavioral Smoking Cessation Treatment for People Living with HIV/AIDS

描述(由申请人提供)：大约50%至70%的人类免疫缺陷病毒(HIV)/自身免疫缺陷综合症(AIDS；PLWHA)患者是尼古丁依赖吸烟者，因此与吸烟相关的发病率和死亡率风险增加。迫切需要有效的戒烟策略，以减少吸烟对PLWHA的健康负担和社会成本。应急管理(CM)治疗在其他人群中减少吸烟是有效的，但到目前为止，还没有发表关于在PLWHA中使用CM戒烟的研究。吸烟的PLWHA将从一家大型城市艾滋病毒/艾滋病治疗诊所招募。所有参与者都将接受为期12周的安非他酮治疗。在第一阶段(第1-4周)，参与者将被随机分配到：1)基于标准护理(SOC)的短暂咨询和安非他酮治疗；或2)SOC加旨在通过提供奖励激励来加强禁欲启动的简短、高级别奖励强化(CM)。在第二阶段(第5-12周)，我们将使用阶梯式护理模式，根据参与者对第一阶段的治疗是否有足够的反应，将他们分配到量身定制的治疗干预中。无反应者将被随机分配到两种为期8周的行为治疗中的一种：1)继续每周咨询和监测吸烟；或2)继续咨询加奖励CM。治疗应答者将被随机分配到：1)不进行额外的行为治疗(与SOC一致)；或2)8周的咨询和监测，外加低强度奖励CM。将在治疗前基线、治疗阶段以及6个月和12个月的随访点对吸烟进行评估。治疗期间的结果衡量标准将包括持续戒烟持续时间最长和生物学证实的吸烟减少(可替宁和过期一氧化碳)。长期结果将包括每一次随访的7天吸烟率。我们预测，在每个治疗阶段，CM患者将比非CM患者减少吸烟更多。这项研究具有很高的创新性，因为它是第一次检查CM的使用情况，并在PLWHA中使用阶梯式戒烟模式。在治疗早期根据患者的结果量身定做戒烟治疗可能会提高戒烟效果，最终可能会降低医疗成本并改善PLWHA的整体健康。因此，该项目具有很高的公共卫生意义。

DESCRIPTION (provided by applicant): Approximately 50% to 70% of people living with Human Immunodeficiency Virus (HIV)/Autoimmune Deficiency Syndrome (AIDS; PLWHA) are nicotine dependent smokers, and thus at increased risk for smoking-related morbidity and mortality. Effective smoking cessation strategies are urgently needed to reduce both the health burden of smoking on PLWHA and costs to society. Contingency management (CM) treatments are efficacious in reducing cigarette smoking in other populations, but to date there are no published studies on the use of CM for smoking cessation in PLWHA. PLWHA who smoke cigarettes will be recruited from a large urban HIV/AIDS treatment clinic. All participants will receive bupropion treatment for 12 weeks. In Phase 1 (weeks 1-4), participants will be randomly assigned to: 1) Brief counseling and bupropion treatment based on standard of care (SoC); or 2) SoC plus brief, high-magnitude prize reinforcement (CM) designed to enhance initiation of abstinence by providing prize incentives. In Phase 2 (weeks 5-12) we will then use a stepped care model to assign participants to a tailored treatment intervention based on whether they respond adequately to the treatment in Phase 1. Non-responders will be randomly assigned to one of two 8-week behavioral treatments: 1) continued weekly counseling and monitoring of smoking; or 2) continued counseling plus prize CM. Treatment responders will be randomly assigned to: 1) no additional behavioral treatment (consistent with SoC); or 2) 8-weeks of counseling and monitoring, plus low-magnitude prize CM. Smoking will be assessed at pre-treatment baseline, during treatment phases, and at 6- and 12-month follow-up points. Outcome measures during treatment will include longest duration of continuous abstinence and biologically verified reduction in smoking (cotinine and expired carbon monoxide). Long-term outcomes will include 7-day point-prevalence of cigarette smoking at each follow-up. We predict CM patients will reduce cigarette smoking more than non-CM conditions in each treatment phase. This study is highly innovative as it is the first to examine the use of CM and to use a stepped care model for smoking cessation among PLWHA. Tailoring smoking cessation treatment on the basis of patient outcome early in treatment may improve smoking cessation effectiveness, and ultimately may reduce healthcare costs and improve the overall health of PLWHA. Thus this project has a high public health significance.