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

摘要 艾滋病毒携带者(PLWH)在戒烟方面被认为是服务不足的人群 鉴于烟草使用率比一般人群高，而且缺乏循证证据 特别是在低收入和中等收入国家(LMIC)为PLWH量身定做的戒烟计划。 尽管已经确定认知行为疗法(CBT)和 药物管理在促进不同人群戒烟方面是有效的，这些 在这些治疗中，循证治疗并没有被证明是有效的/有效的(甚至是可获得的) 病人。我们在PLWH中有或没有先前/当前诊断为结核病主治者的初步数据 巴西的公共卫生系统确定了这些人口在烟草方面面临的多重障碍。 戒烟，包括识字能力有限、习惯性行为、吸烟作为情绪管理、缺乏社交能力 支持、成本、护理距离以及不愿参加提供的可用戒烟计划 出于保密考虑，通过初级保健诊所。这项可行性研究的总体目标是 与公共卫生署和医疗保健提供者合作，调整这些循证方法 与这些人一起工作，并开发、实施和评估理论的可行性和可扩展性- 对通过公共卫生接受护理的长寿妇女进行基于文化的戒烟干预 巴西南部城镇(隆德里纳)的一个系统。我们的形成性评估指出了一种混合的方法：CBT (由临床心理学家提供)+药物治疗(由肺科医生提供)，并增加 虚拟社会支持团体。该方案将重点关注干预措施的开发、预试和可行性 测试。主要结果将是7天的时点戒烟(定义为在 过去7天，通过测量唾液可替宁和呼出的一氧化碳水平来验证)在6- 一个月的随访。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、潜在覆盖面和采用率、与战略背景的一致性)，以提供全面的疗效试验。

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.