Effectiveness of a smoking cessation algorithm integrated into HIV primary care

在美国，吸烟仍然是可预防的死亡和残疾的主要原因。而吸烟 在一般人群中的个体中显著下降，它聚集在 易受伤害的个人，如艾滋病毒/艾滋病患者，其吸烟率和 由此导致的合并症发生率仍然很高。在艾滋病毒治疗方面的医学进步导致了大量的 长寿妇女的预期寿命增加，因此长寿吸烟者现在比以往任何时候都更多地 与烟草有关的疾病和死亡的风险增加。事实上，接受治疗的PLWH吸烟者会损失 现在因吸烟而导致的寿命比因艾滋病毒疾病而延长的寿命更长。尽管PLWH吸烟者从事艾滋病护理工作 通常每4-6个月看一次医生，戒烟治疗和转介通常不是 常规的艾滋病护理。而94%的艾滋病毒治疗提供者表示，他们愿意提供吸烟 在向患者提供戒烟服务方面，很少有人接受过如何提供戒烟服务的培训。 有七种一线药物疗法可用于戒烟，开发算法以帮助 供应商在选择最合适的药物治疗时是一个重要但未经检验的策略，以增加 在普罗旺斯医院戒烟。我们的试点工作为这种方法和我们的干预提供了初步支持 导致更多的禁欲，更多的药物治疗，更多的24小时戒烟尝试，以及 与那些接受标准护理的人相比，戒烟的动机更强。这项建议的目的是 进行一项混合疗效/有效性试验，比较算法治疗与处方成本抵消 并退出行转诊(AT)，照常接受强化治疗(仅退出行转诊；Etau)组。六百 PLWH吸烟者将在阿拉巴马大学伯明翰分校、华盛顿大学和 芬威健康艾滋病毒诊所，并将随机接受AT或Etau。所有AT吸烟者将收到活动 治疗12周，无论声明的戒烟动机或意图如何。埃陶吸烟者将被转介 戒掉专线服务和艾滋病毒提供者可能会选择将吸烟作为标准护理的一部分。参与者将 在研究中停留12个月。主要结果将是6点的吸烟率。 月份。其他令人感兴趣的吸烟相关结果包括24小时戒烟尝试和香烟减少 每天抽一支烟。感兴趣的效果结果包括成本效果分析、吸烟数量 药物治疗处方的书写，以及提供者对治疗吸烟的知识和信心的变化。如果 如果成功，该算法将为用户提供一个易于维护和使用的重要工具 通过电子病历或传输到移动设备，帮助医疗保健专业人员 为PLWH吸烟者提供戒烟治疗。

Smoking remains the leading cause of preventable death and disability in the United States. Whereas smoking has declined significantly among individuals in the general population, it is clustered in populations of vulnerable individuals such as people living with HIV/AIDS (PLWH) in whom smoking prevalence rates and resulting comorbidity rates remain high. Medical advances in the treatment of HIV have resulted in substantial increases in life expectancy among PLWH and as a consequence PLWH smokers are now, more than ever, at heightened risk for tobacco-related illnesses and death. In fact, PLWH smokers engaged in treatment lose more years of life due to smoking now than to HIV disease. Although PLWH smokers engaged in HIV care typically see a medical provider every 4-6 months, smoking cessation treatment and referral is often not part of routine HIV care. While 94% of HIV treatment providers indicated that they would be willing to provide smoking cessation services to their patients, few have received training in how to provide smoking cessation services. With seven first line pharmacotherapies available for smoking cessation, development of algorithms to assist providers in selecting the most appropriate pharmacotherapy is an important but untested strategy to increase smoking cessation in PLWH. Our pilot work has provided initial support for this approach and our intervention has resulted in increased abstinence, higher use of pharmacotherapy, increased 24-hour quit attempts, and enhanced in motivation to quit, compared to those receiving standard of care. The purpose of this proposal is to conduct a mixed efficacy/effectiveness trial comparing an algorithm treatment with prescription cost off sets and quit line referral (AT) to an enhanced Treatment as Usual (quit line referral only; eTAU) group. Six hundred PLWH smokers will be recruited at the University of Alabama at Birmingham, University of Washington, and Fenway Health HIV clinics and will be randomized to receive AT or eTAU. All AT smokers will receive active treatment for twelve weeks regardless of stated motivation or intention to quit. eTAU smokers will be referred to quit line services and HIV providers may elect to treat smoking as part of standard of care. Participants will remain in the study for 12 months. The primary outcome will be point prevalence smoking abstinence at 6 months. Other smoking-related outcomes of interest include 24-hour quit attempts and reduction in cigarettes smoked per day. Effectiveness outcomes of interest include cost effectiveness analyses, number of smoking pharmacotherapy prescriptions written, and change in provider knowledge and confidence to treat smoking. If successful, this algorithm could provide an important tool that could be easily sustained and available for use through the electronic medical record or transferred to a mobile device to aid health care professionals in providing smoking cessation treatment to PLWH smokers.