A Peer Navigator Model to Improve Quit Attempts, Quitline Use, and Smoking Cessation Rates among HIV-positive smokers

摘要 与美国相比，吸烟在美国艾滋病病毒携带者(PLWH)中更为普遍 并与这一人群中发病率和死亡率的增加有关。此外，艾滋病毒- 吸烟成瘾的人患肺癌和其他与吸烟有关的癌症的几率更高。因为它们的水平很高 由于尼古丁依赖、戒烟率低以及对戒烟治疗的依从性差，PLWH可能会 与普通吸烟者相比，戒烟需要额外的支持。对等导航器(PNS) 已用于艾滋病毒护理，以提高进入护理的比率，坚持治疗，并保留在 关心。将HIV阳性吸烟者与成功戒烟的PN联系起来可能会改善吸烟状况 PLWH中的戒断结果。这个项目的主要目标是研究可行性和 同伴导航戒烟社会支持(PNSS-S)对HIV阳性患者干预的可接受性 吸烟者。我们将确定加强治疗(使用PN导航戒烟，是否有帮助 获得药物和治疗，提高治疗依从性，并为戒烟提供社会支持)将 戒烟尝试和戒烟率(以7天点流行率衡量)比 标准护理(SC；提供者建议退出并退出使用5A的线路转诊)。我们还将获得 PNSS-S干预与SC干预的效应大小估计。我们将在开放的环境中测试初始协议 飞行员有六名艾滋病毒阳性吸烟者和两名PNS。研究参与者、PNS和研究护士将提供 正在进行反馈，以修订初步议定书。然后，我们将对72名HIV阳性患者进行试点随机对照试验 吸烟者检查新干预措施的可行性、可接受性和初步疗效 标准护理超过24周的随访。这项研究将是第一次检查可行性和初步 使用三七总皂甙改善PLWH患者戒烟效果的一种新干预措施的有效性。给定 在PLWH中吸烟的高流行率和与之相关的显著发病率， 降低这一群体吸烟相关风险的有效策略至关重要。如果被确定为 这种干预措施有效，可以很容易地在艾滋病毒诊所传播。我们的研究将提供关键 关于在人群中将PNS纳入戒烟计划的潜在好处的信息 它高度依赖尼古丁，极易受到与吸烟相关的发病率和死亡率的影响。

ABSTRACT Cigarette smoking is more prevalent in persons living with HIV (PLWH) in the U.S. when compared with the general population and is linked to increased morbidity and mortality in this population. Furthermore, HIV- positive smokers have increased rates of lung and other smoking-related cancers. Because of their high levels of nicotine dependence, low quit rates, and poor adherence to smoking cessation treatments, PLWH may require additional support for quitting compared with the general population of smokers. Peer Navigators (PNs) have been used in HIV care to improve rates of entry into care, adherence with treatment, and retention in care. Linking HIV-positive smokers with a PN who has quit smoking successfully may improve smoking cessation outcomes among PLWH. The primary objectives of this project is to examine the feasibility and acceptability of a peer navigation social support for smoking cessation (PNSS-S) intervention for HIV-positive smokers. We will determine whether enhanced treatment (using a PN to navigate smoking cessation, help obtain medication and treatment, improve adherence to treatment, and provide social support for quitting) will increase quit attempts and smoking cessation rates (measured by 7-day point prevalence) compared with standard care (SC; provider recommendation to quit and quit line referral using the 5A’s). We will also obtain an effect size estimate for the PNSS-S intervention compared to SC. We will test the initial protocol in an open pilot with six HIV-positive smokers and two PNs. Study participants, PNs, and the study nurse will provide ongoing feedback to revise the preliminary protocol. We will then conduct a pilot RCT with 72 HIV-positive smokers to examine the feasibility, acceptability, and initial efficacy of the novel intervention compared to standard care over 24 weeks of follow-up. This study will be the first to examine the feasibility and initial efficacy of a novel intervention using PNs to improve smoking cessation outcomes in PLWH. Given the high prevalence of smoking and the significant morbidity associated with it in PLWH, the development of effective strategies to reduce the risks related to smoking in this group is critical. If determined to be effective, this intervention could be readily disseminated in HIV clinics. Our study will provide key information on the potential benefit of engaging PNs into a smoking cessation program in a population that is highly dependent on nicotine and highly vulnerable to smoking-related morbidity and mortality.