HIV-positive (HIV+) populations have higher rates of smoking than the general population and smoking puts HIV+ individuals at higher risk for HIV-related health problems. Also, HI-V+ smokers face psychological, medical, and interpersonal issues that may influence smoking, motivation to quit, and success in quitting. Although many HIV+ smokers are interested in quitting, few are referred to or receive cessation services.
The specific aims of this TRC component are to determine the efficacy and cost-effectiveness of innovative targeted smoking treatments that incorporate behavioral interventions designed to address the unique needs of the HIV+smoker. Consistent with the TRC core theme of providing treatment to complex patients in novel settings, all treatments will be provided in HIV clinical care settings. The proposed study uses a three-group parallel design. 360 HIV+ cigarette smokers will be recruited and randomly assigned to one of three smoking treatments; a) targeted individual counseling, b) targeted computer-based counseling, or c) minimal contact control condition. Both targeted interventions include educational and motivational information on smoking and HIV-disease, a mood management component, stress management training, and a social support component. The minimal-contact control condition provides a self-help publication. Participants in all three conditions have access to nicotine replacement treatment. To evaluate the efficacy of the interventions, smoking status will be assessed at 3, 6, 9, and 12 months following treatment initiation. Measures of treatment costs and health care utilization will be obtained to determine cost-utility of the interventions. Exploratory analyses will be completed to identify predictors of treatment success or failure in this group of smokers. Data from this component will also be combined with data from other TRC components to examine the reciprocal effects of nicotine and alcohol the effects of multiple risk behaviors on treatment outcome, and the characteristics of complex patients.
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