Computer-based MI to engage smokers living with HIV in tobacco quitline treatment

描述(由申请人提供)：美国艾滋病病毒携带者(PLWH)的吸烟流行率估计为40%-70%，因为普通人群的吸烟率已下降到20.6%。烟草使用对PLWH具有重大的健康后果，占使用高效抗逆转录病毒疗法(HAART)的PLWH多国队列中所有死亡人数的近25%。烟草、HIV病毒和HAART之间的相互作用使吸烟的PLWH比没有吸食艾滋病毒的吸烟者更容易患上心血管和肺部疾病，也增加了他们患多种艾滋病毒相关疾病的风险。在这一背景下，关于PLWH的戒烟干预措施的研究发表得很少，也没有人评估可以轻松传播并整合到标准艾滋病毒护理中的方法。这项研究计划的长期目标是传播一种有效的、简短的基于计算机的干预措施，这种干预措施可以很容易地整合到艾滋病毒治疗环境中，以鼓励携带艾滋病毒的吸烟者使用烟草奎宁。该应用程序的总体目标是开发这种计算机干预，根据初始引导和反馈对其进行修改，并获得支持干预效果的初步数据。这将通过追求三个具体目标来实现：1)开发和进行初步试点测试(n=16)，目的是在艾滋病毒携带者(CI-METQ)中鼓励吸烟者使用烟草奎宁(CI-METQ；(2)对100名接受戒烟治疗的人进行一项初步的戒烟随机对照试验，比较CI-METQ和NC，预测CI-METQ与NC相比，在1-3和6个月的随访中，CI-METQ与NC相比将导致更高的戒烟准备、更高的烟草治疗参与率、更多的戒烟尝试和更高的7天时点戒烟率。还将检查这段时间内与健康相关的生活质量，以及3)检查CI-METQ在计算机会话期间对关键机制的影响，以及它们与1个月、3个月和6个月随访的烟草治疗参与度和吸烟结果的关系。这项研究的创新之处在于：1)以前的研究没有针对PLWH中的烟草使用实施基于计算机的动机干预；2)本申请中提出的CI-METQ本身侧重于促进烟草治疗的参与，而不是戒烟本身；以及3)以前的研究没有试图将PLWH吸烟者与免费的烟草戒烟线联系起来，这是一种有效和容易获得的资源。CI-METQ将有可能在艾滋病毒治疗环境中广泛传播，如果有效，将在降低吸烟相关发病率和死亡率以及促进使用简短的计算机干预改变PLWH健康危险行为的科学知识方面产生重大的整体影响。

DESCRIPTION (provided by applicant): The prevalence of cigarette smoking among people living with HIV (PLWH) in the U.S. is estimated at 40-70%, as the smoking rate in the general population has declined to 20.6%. Tobacco use has significant health consequences for PLWH, accounting for nearly 25% of all deaths in a multinational cohort of PLWH who used highly active antiretroviral therapy (HAART). Interactions among tobacco, the HIV virus, and HAART render PLWH who smoke even more susceptible than smokers without HIV to cardiovascular and lung diseases, and also increases their risk for a multitude of HIV-related illnesses. Against this backdrop, very little research on smoking cessation interventions for PLWH has been published, and none has evaluated approaches that could be easily disseminated and integrated into standard HIV care. The long-term goal of this program of research is to disseminate an effective, brief computer-based intervention that can be readily integrated into HIV treatment settings to motivate tobacco quitline use among smokers living with HIV. The overall objective of this application is to develop this computer intervention, modify it based on initial piloting and feedback, and obtain preliminary data supporting the efficacy of the intervention. This will be accomplished by pursuing three specific aims: 1) to develop and conduct preliminary pilot testing (n=16) of a brief, computer- based intervention intended to motivate tobacco quitline use among cigarette smokers living with HIV (CI- METQ; Computer Intervention to Motivate Engagement in Tobacco Quitline treatment) and to develop and pilot (n=4) a computer-based, time matched nutrition education for PLWH control intervention (NC) equated for the offer of a tobacco quitline referral and 8 weeks of free nicotine patch for those who engage in quitline treatment, 2) to conduct a preliminary smoking cessation RCT with 100 PLWH, comparing CI-METQ vs. NC, with predictions that CI-METQ relative to NC will result in increased readiness, higher rates of tobacco treatment engagement, more quit smoking attempts and higher rates of 7-day point prevalence abstinence rates at 1-, 3- and 6-month follow-ups. Health-related quality of life over this period will also be examined, and 3) to examine CI-METQ's effects on key mechanisms during the computer session and their associations with tobacco treatment engagement and smoking outcomes at 1-, 3- and 6-month follow-ups. The research proposed is innovative in that: 1) no previous studies have implemented a computer-based motivational intervention targeting tobacco use in PLWH, 2) the CI-METQ proposed in this application is focused on promoting tobacco treatment engagement rather than smoking cessation, per se, and 3) no previous studies have attempted to link PLWH smokers with free tobacco quitlines, an efficacious and readily available resource. The CI-METQ will have potential for broad reach within HIV treatment settings and if effective, will have significant overall impact in reducing smoking-related morbidity and mortality and in advancing scientific knowledge regarding the use of brief, computer interventions to change health risk behaviors in PLWH.