Treatment Development for Smoking Cessation and Engagement in HIV/TB Care in South Africa

概述：这项提案直接解决了影响 南非艾滋病毒携带者(PWH)和/或结核病(TB)患者的健康和生存情况：吸烟。 背景/意义：吸烟降低了PWH患者抗逆转录病毒治疗(ART)的依从性， 影响艾滋病毒治疗结果，并与新患者中较低的结核病治疗依从性有关 被诊断为结核病，以及结核病治疗失败，在治疗期间失去随访，以及在或 治疗后。 初步研究：在R34的应用中，我们建议开发一种量身定制的戒烟干预措施 在SA的背景下，改善艾滋病毒和结核病的疾病结果，将我们从 两个相互重叠的研究领域。首先，我们完成了一项随机对照试验(RCT)，它建立了最初的 认知行为疗法戒烟干预(戒烟)的有效性、可行性和可接受性 美国的PWH，与对照组相比，6个月后生物验证的禁酒率增加了1 其次，我们最近完成了一项认知行为艺术依从性的有效性/有效性试验 干预，成功地提高了艾滋病治疗的依从性，并降低了开普敦威尔斯亲王医院的病毒载量 因此，我们在美国和南澳的研究团队在戒烟治疗方面拥有专业知识 慢性病患者和适应循证认知行为策略的发展 在低资源环境下坚持治疗。 方法：我们现在建议通过开发戒烟AD来扩展这一工作实体，这是一种新的干预措施，将 将我们的戒烟计划与认知行为策略相结合，这些策略已经在文化上进行了调整以提高 SA中PWH和/或TB患者的治疗依从性。为此，我们将：更彻底地了解(A)障碍 在感染艾滋病毒和/或结核病的成年人中戒烟和(B)成年人坚持结核病治疗的障碍 对使用烟草的结核病患者(目标1)；调整戒烟方案，根据需要适当增加和删除内容 根据形成的数据，进行一项小型概念验证开放试验(n=5；目标2)；并评估可行性 以及将试点随机对照试验中的干预任务转移到非专业辅导员的可接受性(目标3)。次要的 随机对照试验的结果将是经过生物学验证的烟草戒断点流行率、香烟数量 在过去的一周内吸烟，并在6个月内获得良好的艾滋病毒/结核病治疗结果。 成果/下一步：这些目标将为全面、混合的效力/实施奠定基础 一项可能改变SA戒烟治疗格局的试验，提供了一个经验支持的 威斯康星和/或结核病方案，并作为未来工作的典范，以维持在 在资源有限的环境中患有慢性病的个人。

Overview: This proposal directly addresses one of the most critical public health challenges impacting the health and survival of people with HIV (PWH) and/or tuberculosis (TB) in South Africa (SA): smoking. Background/Significance: Smoking reduces antiretroviral therapy (ART) adherence among PWH, compromising HIV treatment outcomes, and is linked to lower TB treatment adherence among patients newly diagnosed with TB, as well as to TB treatment failure, loss to follow up during treatment, and death during or after treatment. Preliminary studies: In this R34 application, we propose to develop a smoking cessation intervention tailored to the SA context that improves disease outcomes for both HIV and TB, bringing together our experience from two overlapping areas of research. First, we completed a randomized controlled trial (RCT) that established initial efficacy, feasibility, and acceptability of a cognitive behavioral therapy smoking cessation intervention (QUIT) for PWH in the US, which increased biologically-verified abstinence rates at 6 months compared to controls.1 Second, we recently completed an efficacy/effectiveness trial of a cognitive behavioral ART adherence intervention, which successfully increased HIV treatment adherence and reduced viral load among PWH in Cape Town.2 Therefore, our US- and SA-based investigator team has expertise in smoking cessation treatment development for individuals with chronic disease and in adapting evidence-based, cognitive behavioral strategies for treatment adherence in a low-resource setting. Approach: We now propose to extend this body of work by developing QUIT-AD, a novel intervention which will integrate our QUIT program with cognitive behavioral strategies that have been culturally adapted to improve treatment adherence among PWH and/or TB in SA. To do so, we will: more thoroughly understand (a) barriers to smoking cessation among adults with HIV and/or TB and (b) barriers to TB treatment adherence among adults with TB who use tobacco (Aim 1); adapt the QUIT protocol, adding and removing content as appropriate based on the formative data, and conduct a small proof-of-concept open trial (n = 5; Aim 2); and assess the feasibility and acceptability of the intervention in a pilot RCT to be task shifted to lay counselors (Aim 3). Secondary outcomes of the RCT will be biologically-verified point prevalence tobacco abstinence, number of cigarettes smoked in the past week, and favorable HIV/TB treatment outcome at 6 months. Outcomes/next steps: These aims will lay the groundwork for a full-scale, hybrid effectiveness/implementation trial which could change the smoking cessation treatment landscape in SA, provide an empirically supported program for PWH and/or TB, and serve as a model for future work to sustain smoking abstinence among individuals with chronic diseases in resource-limited settings.