Development, Implementation, and Evaluation of a Tobacco Cessation Intervention Tailored to Persons Living with HIV (PLWH) in Brazil: A Feasibility Study

摘要 艾滋病毒感染者（PLWH）被认为是戒烟服务不足的人群 鉴于与一般人群相比，烟草使用的流行率很高， 针对艾滋病毒携带者的戒烟计划，特别是在低收入和中等收入国家（LMIC）。 虽然它已被公认为认知行为疗法（CBT）和 药物管理在促进不同人群戒烟方面是有效的，这些 基于证据的治疗方法尚未被证明是有效的/有效的（甚至是可获得的）， 患者我们在既往/当前诊断为结核病的PLWH中的初步数据 巴西的公共卫生系统确定了这一人群在烟草方面面临的多重障碍 戒烟，包括有限的识字，习惯性行为，烟草使用作为情绪管理，缺乏社会 支持、成本、距离护理以及不愿意参加提供的戒烟计划 由于保密问题，通过初级保健诊所。本可行性研究的总体目标是 与艾滋病毒携带者和卫生保健提供者合作，对这些基于证据的方法进行调整 与这些人一起工作，开发，实施和评估理论的可行性和可扩展性- 对通过公共卫生机构接受治疗的艾滋病毒携带者进行基于文化的戒烟干预 在巴西南部城镇（隆德里纳）的系统。我们的形成性评估指出了一种混合方法：CBT （由临床心理学家提供）+药物治疗（由肺病学家提供）， 虚拟社会支持小组该提案将侧重于干预开发、预测试和可行性 试验.主要结果将是7天的时点戒烟率（定义为 过去7天，并通过测量唾液可替宁和呼出的一氧化碳水平进行验证） 月随访。我们还将进行详细的治疗保真度和可扩展性评估（可接受性， 可行性，潜在的覆盖范围和采用，与战略背景的一致性），以告知全面的疗效试验。

Abstract Persons Living with HIV (PLWH) are considered an underserved population with regard to tobacco cessation given the high prevalence of tobacco use compared to the general population and the lack of evidence-based tobacco cessation programs tailored to PLWH, particularly in low- and middle-income countries (LMICs). Although it has been well established that a combination of cognitive behavioral therapy (CBT) and pharmacological management is efficacious in promoting tobacco cessation across diverse populations, these evidence-based treatments have not proven to be effective/efficacious (or even accessible) among these patients. Our preliminary data among PLWH with or without a prior/current diagnosis of tuberculosis attending the public health system in Brazil identified multiple barriers faced by this population with regard to tobacco cessation, including limited literacy, habitual behavior, tobacco use as mood management, lack of social support, cost, distance to care, and reluctance to attend the available tobacco cessation program offered through the primary care clinics due to confidentiality concerns. The overall goal of this feasibility study is to make adaptations to these evidence-based approaches in collaboration with PLWH and health care providers working with this population, and develop, implement, and evaluate the feasibility and scalability of a theory- based, culturally relevant tobacco cessation intervention for PLWH receiving care through the public health system in a southern town in Brazil (Londrina). Our formative assessments point to a mixed approach: CBT (delivered by a Clinical Psychologist) + pharmacotherapy (delivered by a Pulmonologist) augmented by a virtual social support group. This proposal will focus on the intervention development, pretesting, and feasibility testing. The primary outcome will be a 7-day point prevalence abstinence (defined as no tobacco use in the past 7 days and verified through measurement of salivary cotinine and exhaled carbon monoxide levels) at 6- month follow-up. We will also conduct detailed treatment fidelity and scalability assessments (acceptability, feasibility, potential reach and adoption, alignment with the strategic context) to inform a full-scale efficacy trial.