The prevalence of cigarette smoking among people living with HIV (PLWH) in the U.S. is estimated at 40-70%, as the smoking rate in the general population has declined to 20.6%. Tobacco use has significant health consequences for PLWH, accounting for nearly 25% of all deaths in a multinational cohort of PLWH who used highly active antiretroviral therapy (HAART). Interactions among tobacco, the HIV virus, and HAART render PLWH who smoke even more susceptible than smokers without HIV to cardiovascular and lung diseases, and also increases their risk for a multitude of HIV-related illnesses. Against this backdrop, very little research on smoking cessation interventions for PLWH has been published, and none has evaluated approaches that could be easily disseminated and integrated into standard HIV care. The long-term goal of this program of research is to disseminate an effective, brief computer-based intervention that can be readily integrated into HIV treatment settings to motivate tobacco quitline use among smokers living with HIV. The overall objective of this application is to develop this computer intervention, modify it based on initial piloting and feedback, and obtain preliminary data supporting the efficacy of the intervention. This will be accomplished by pursuing three specific aims: 1) to develop and conduct preliminary pilot testing (n=16) of a brief, computer- based intervention intended to motivate tobacco quitline use among cigarette smokers living with HIV (CI- METQ;Computer Intervention to Motivate Engagement in Tobacco Quitline treatment) and to develop and pilot (n=4) a computer-based, time matched nutrition education for PLWH control intervention (NC) equated for the offer of a tobacco quitline referral and 8 weeks of free nicotine patch for those who engage in quitline treatment, 2) to conduct a preliminary smoking cessation RCT with 100 PLWH, comparing CI-METQ vs. NC, with predictions that CI-METQ relative to NC will result in increased readiness, higher rates of tobacco treatment engagement, more quit smoking attempts and higher rates of 7-day point prevalence abstinence rates at 1-, 3- and 6-month follow-ups. Health-related quality of life over this period will also be examined, and 3) to examine CI-METQ's effects on key mechanisms during the computer session and their associations with tobacco treatment engagement and smoking outcomes at 1-, 3- and 6-month follow-ups. The research proposed is innovative in that: 1) no previous studies have implemented a computer-based motivational intervention targeting tobacco use in PLWH, 2) the CI-METQ proposed in this application is focused on promoting tobacco treatment engagement rather than smoking cessation, per se, and 3) no previous studies have attempted to link PLWH smokers with free tobacco quitlines, an efficacious and readily available resource. The CI-METQ will have potential for broad reach within HIV treatment settings and if effective, will have significant overall impact in reducing smoking-related morbidity and mortality and in advancing scientific knowledge regarding the use of brief, computer interventions to change health risk behaviors in PLWH.
The proposed research is relevant to public health because people living with HIV (PLWH) who smoke suffer from disproportionately high rates of tobacco morbidity and mortality, and yet very little research on smoking cessation interventions for PLWH has been published, and none has evaluated approaches that could be easily disseminated and integrated into standard HIV care. The overall objective of this application is to develop and obtain preliminary data supporting the efficacy of a brief, computer-based intervention that can be readily integrated into HIV treatment settings to motivate tobacco quitline use in patients who smoke. It is anticipated that the computer-based intervention resulting from this project will have potential for broad reach to HIV treatment settings and if effective in motivating tobacco quitline use among smokers living with HIV, will have significant overall impact in reducing smoking-related morbidity and mortality among PLWH and in advancing scientific knowledge regarding the application of brief, computer-based interventions to change health risk behaviors in PLWH.
