Cultural Adaptation and Piloting of a Smoking Cessation Intervention for Smokers With HIV
Condition: Hiv; Cigarette Smoking
Study type: Interventional

Summary: 
      One population of tobacco users that is severely affected by the consequences of smoking is
      people living with HIV (PLWH). Between 40-84% of PLWH smoke, a percentage that has remained
      constant since the first studies of smoking in HIV were conducted in the 1990's. Overall,
      smoking related morbidity and mortality is also greatly increased among PLWH smokers.
      Compared with PLWH nonsmokers, PLWH who smoke have more than 5 times the risk of
      non-HIV-related mortality and almost 4 times the risk of all-cause mortality. Compared with
      the general population, incidence ratio of smoking related cancers (eg, lung, head, neck,
      bladder and esophageal) is more than 5 times higher. At a critical time when advances in HIV
      care are providing an opportunity for prolonged life, smoking is significantly impeding the
      health of PLWH.

      To produce meaningful changes in smoking, however, treatment will have to be acceptable and
      engaging to this population as well as feasible and sustainable to implement in a busy
      clinic. Novel technology-based interventions that incorporate evidence-based behavioral and
      pharmacologic interventions for smoking and are culturally tailored offer real solutions to
      these implementation barriers. Research shows that internet- or computer-delivered
      interventions (CDI) that are tailored and interactive can be efficacious in reducing smoking
      and are significantly more effective than usual care or written self-help materials. CDIs can
      also be readily adapted to different sociodemographic characteristics of a patient population
      because content is modular and menu driven. Moreover, technology-based interventions appear
      as effective as counselor-delivered interventions in reducing smoking. This growing body of
      evidence strongly suggests that these interventions offer promise in reducing smoking, the
      potential to reach significantly more patients, and the ability to overcome barriers of cost,
      implementation, and cultural nonspecificity. The goal of this pilot study is test to examine
      feasibility, acceptability of a computer-delivered smoking cessation intervention for PLWH,
      and to determine if intervention participation results in increased readiness to quit smoking
      and increased confidence in ability to quit smoking.
    

Detailed description: 
      One population of tobacco users that is severely affected by the consequences of smoking is
      people living with HIV (PLWH). Between 40-84% of PLWH smoke, a percentage that has remained
      constant since the first studies of smoking in HIV were conducted in the 1990's. Overall,
      smoking related morbidity and mortality is also greatly increased among PLWH smokers.
      Compared with PLWH nonsmokers, PLWH who smoke have more than 5 times the risk of
      non-HIV-related mortality and almost 4 times the risk of all-cause mortality. Compared with
      the general population, their incidence ratio of smoking related cancers (eg, lung, head,
      neck, bladder and esophageal) is more than 5 times higher. At a critical time when advances
      in HIV care are providing an opportunity for prolonged life, smoking is significantly
      impeding the health of PLWH.

      To produce meaningful changes in smoking, however, treatment will have to be acceptable and
      engaging to this population as well as feasible and sustainable to implement in a busy
      clinic. Novel technology-based interventions that incorporate evidence-based behavioral and
      pharmacologic interventions for smoking and are culturally tailored offer real solutions to
      these implementation barriers. Research shows that internet- or computer-delivered
      interventions (CDI) that are tailored and interactive can be efficacious in reducing smoking
      and are significantly more effective than usual care or written self-help materials. CDIs can
      also be readily adapted to different sociodemographic characteristics of a patient population
      because content is modular and menu driven. Moreover, technology-based interventions appear
      as effective as counselor-delivered interventions in reducing smoking. This growing body of
      evidence strongly suggests that these interventions offer promise in reducing smoking, the
      potential to reach significantly more patients, and the ability to overcome barriers of cost,
      implementation, and cultural nonspecificity. The goal of this pilot randomized controlled
      trial (RCT) is study is test to examine feasibility, acceptability of a computer-delivered
      smoking cessation intervention for PLWH, and to determine if intervention participation
      results in increased readiness to quit smoking and increased confidence in ability to quit
      smoking.To pilot test the computer-delivered intervention among 40 individuals with HIV
      receiving care in an urban HIV clinic in a small Randomized Controlled Trial 2a) To determine
      intervention effect on 1) readiness to quit smoking 2) increased confidence in ability to
      quit smoking 2) uptake of smoking cessation therapy, including a. Quit Line, b. Nicotine
      replacement therapy c. Pharmacotherapy (varenicline, Wellbutrin) Hypothesis: Investigators
      hypothesize that intervention participation will be associated with 1) increased readiness to
      quit and confidence in quitting smoking and 2) increased engagement with smoking cessation
      services.

      2b) To examine feasibility and acceptability of delivering the computer-delivered smoking
      cessation counseling in this setting.
    

Intervention name(s): Computer delivered smoking cessation counseling
Intervention type(s): Behavioral
Intervention description(s): 15 to 20 minute computer-delivered interactive smoking cessation counseling
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 2 arm, RCT with waitlist control
Masking: Single (Investigator)
Primary purpose: Treatment