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Sanford BT, Toll BA, Eckard AR, Sterba KR, Cummings KM, Baker NL, Rojewski AM. Optimizing tobacco treatment delivery for people with HIV: trial protocol for a randomized controlled trial. Addict Sci Clin Pract 2022; 17:61. [PMID: 36335376 PMCID: PMC9636678 DOI: 10.1186/s13722-022-00341-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/09/2022] [Accepted: 10/03/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND With advances in antiretroviral therapy, people with HIV (PWH) are living longer and are less likely to die from AIDS-related complications. Yet, prior research has shown that smoking is often not addressed in the context of HIV care, and few individuals are offered cessation treatment. Optimizing tobacco treatment delivery for PWH may increase engagement with evidence-based treatments and successful quit attempts. METHODS The current study is a type 1 hybrid effectiveness-implementation trial to evaluate the impact of a proactive, opt-out tobacco treatment intervention on cessation outcomes and advance understanding of key barriers and facilitators of implementation processes. A total of 230 PWH who smoke will be recruited from an infectious diseases clinic at an academic medical center and will be randomized to receive (1) treatment as usual (TAU) or (2) Proactive Outreach with Medication Opt-out for Tobacco Treatment Engagement (PrOMOTE). Primary outcomes include: biochemically verified 7-day point prevalence abstinence (PPA) rates, continuous abstinence (Weeks 9-12), and the number of 24-hour quit attempts at the end of study treatment (Week 12). Secondary outcomes include: participant reach (proportion reached out of contact attempts), implementation fidelity (including number of prescriptions written), participant adherence to prescribed pharmacotherapy, acceptability (participant and provider satisfaction with intervention delivery and content), and perceived barriers. DISCUSSION This study will examine a novel approach to optimizing tobacco treatment delivery for PWH. Integrating effectiveness and implementation results will help define best practices for engaging PWH with evidence-based tobacco treatment interventions. The intervention is low-cost, has the potential to be highly scalable, and could be translatable to other ambulatory HIV clinic settings. TRIAL REGISTRATION ClinicalTrials.gov: NCT05019495 (August 24, 2021).
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Affiliation(s)
- Brandon T. Sanford
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA
| | - Benjamin A. Toll
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA ,grid.467988.c0000 0004 0390 5438Hollings Cancer Center, Charleston, SC USA
| | - Allison Ross Eckard
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA
| | - Katherine R. Sterba
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA
| | - K. Michael Cummings
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA ,grid.467988.c0000 0004 0390 5438Hollings Cancer Center, Charleston, SC USA
| | - Nathaniel L. Baker
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA
| | - Alana M. Rojewski
- grid.259828.c0000 0001 2189 3475Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, MSC 835, 29425 Charleston, SC USA ,grid.467988.c0000 0004 0390 5438Hollings Cancer Center, Charleston, SC USA
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Mann-Jackson L, Choi D, Sutfin EL, Song EY, Foley KL, Wilkin AM, Morse CG, Rojas NF, Oh TS, Rhodes SD. A Qualitative Systematic Review of Cigarette Smoking Cessation Interventions for Persons Living with HIV. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:1045-1058. [PMID: 31037506 PMCID: PMC6819245 DOI: 10.1007/s13187-019-01525-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Persons living with HIV (PLWH) have disproportionately high rates of both cigarette smoking and tobacco-induced negative health outcomes. The goal of this qualitative systematic review was to identify gaps in the existing literature and future directions for smoking cessation support for PLWH. Three online databases were searched from their inception through December 31, 2017, using designated search terms. Peer-reviewed English-language articles that documented an intervention designed to increase smoking cessation among PLWH were reviewed. Data were abstracted using a standardized form to document study and intervention characteristics and results. Thirty-two articles, describing 28 unique intervention studies, met inclusion criteria. Interventions consisted primarily of combinations of counseling, pharmacotherapy, and the use of information and communications technology; few interventions were implemented at the clinic level. Thirteen interventions resulted in significant improvements in cessation-related outcomes. Information and communications technology and clinic-level interventions had the greatest potential for increasing smoking cessation among PLWH. Efficacious interventions designed for PLWH in the US South, and for groups of PLWH facing additional health disparities (e.g., communities of color and sexual and gender minorities), are needed. There is also a need for more rigorous research designs to test the efficacy of interventions designed to increase cessation-related outcomes among PLWH.
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Affiliation(s)
- Lilli Mann-Jackson
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
- Wake Forest Clinical and Translational Science Institute Program in Community Engagement, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - David Choi
- Stanford University, 401 Quarry Road, Palo Alto, CA, 94304, USA
| | - Erin L Sutfin
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Eunyoung Y Song
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Kristie L Foley
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Aimee M Wilkin
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Caryn G Morse
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Nicole F Rojas
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Timothy S Oh
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Scott D Rhodes
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Wake Forest Clinical and Translational Science Institute Program in Community Engagement, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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Musumari PM, Tangmunkongvorakul A, Srithanavibooncha K, Feldman MD, Sitthi W, Rerkasem K, Techasrivichien T, Suguimoto SP, Ono-Kihara M, Kihara M. Socio-behavioral risk factors among older adults living with HIV in Thailand. PLoS One 2017; 12:e0188088. [PMID: 29136655 PMCID: PMC5685602 DOI: 10.1371/journal.pone.0188088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There has been a global increase in HIV infection in persons 50 years of age and older. This group is at risk for development of chronic illness that may be exacerbated by socio-behavioral risk factors such as smoking, unhealthy alcohol use, and sedentary lifestyle. However, socio-behavioral risk factors in this older HIV infected population are not well described. The current study aims to describe and document factors related to alcohol use, tobacco smoking, and physical exercise in older adults living with HIV (OALHIV). METHODS This cross-sectional quantitative study was conducted between August and September 2015, and enrolled HIV-infected participants aged 50 years and older from 12 community hospitals in Chiang Mai Province, Northern Thailand. RESULTS Of the 364 participants recruited in the study, 57.1% were female, and 67.3% were between 50-59 years of age. Respectively, 15.1%, 59.1%, and 18.7% were current smokers, currently engaged in physical exercises, and reported ever drank alcohol in the past year. 22.1% of those who drank alcohol reported experience of heavy episodic drinking. Male gender was one of the strongest predictors of ever drank alcohol in the past year (AOR, 4.66; CI, 2.28-9.49; P<0.001) and of being a current smoker (AOR, 13.41; CI, 7.23-24.87; P<0.001). Lower household income was associated with increased odds of ever drank alcohol in the past year (household income (1 USD = 35 THB) of ≤ 5,000 Baht versus > 20,000 Baht: AOR, 5.34; CI, 1.28-22.25; P = 0.021). Lower educational level was associated with decreased odds of physical exercises (no education versus secondary and higher: AOR, 0.22; CI, 0.08-0.55; P = 0.001). CONCLUSION Smoking and alcohol use is common among OALHIV, with a substantial proportion not engaging in physical exercises. Interventions for OALHIV should particularly target males and those of lower socio-economic status to deter smoking and alcohol use and to promote physical exercises.
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Affiliation(s)
- Patou Masika Musumari
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan
| | | | - Kriengkrai Srithanavibooncha
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Mitchell D. Feldman
- Division of General Internal Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Wathee Sitthi
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipan Rerkasem
- Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Teeranee Techasrivichien
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan
| | - S. Pilar Suguimoto
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan
- Center for Medical Education, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masako Ono-Kihara
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan
| | - Masahiro Kihara
- Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan
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Parienti JJ, Merzougui Z, de la Blanchardière A, Dargère S, Feret P, Le Maitre B, Verdon R. A Pilot Study of Tobacco Screening and Referral for Smoking Cessation Program among HIV-Infected Patients in France. J Int Assoc Provid AIDS Care 2017; 16:467-474. [PMID: 28578610 DOI: 10.1177/2325957417711253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prevalence of tobacco smoking is high among patients living with HIV, supporting the need for effective targeted interventions. MATERIALS AND METHODS All current smokers at our outpatient HIV clinic were invited to participate in a smoking cessation program. RESULTS Of the 716 patients living with HIV, 280 (39%) reported active smoking and were younger, more recently HIV infected and more frequently infected due to intravenous drug use (IDU). One hundred forty-seven (53%) smokers agreed to participate in the smoking cessation program and had a higher Fagerström score and were less likely IDU. During follow-up, 41 (28%) smokers withdrew from the program. After 6 months, 60 (57%) of the 106 smokers who completed the intervention had stopped tobacco smoking and were more likely to use varenicline, adjusting for a history of depression. CONCLUSION Our smoking cessation program was feasible. However, strategies to reach and retain in smoking cessation program specific groups such as IDU are needed to improve the smoking cessation cascade.
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Affiliation(s)
- Jean-Jacques Parienti
- 1 Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France
- 2 Department of Infectious Diseases, Caen University Hospital, Caen, France
- 3 EA 2656, Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Caen Normandie Université, Caen, France
| | - Zine Merzougui
- 1 Department of Biostatistics and Clinical Research, Caen University Hospital, Caen, France
| | | | - Sylvie Dargère
- 2 Department of Infectious Diseases, Caen University Hospital, Caen, France
| | - Philippe Feret
- 2 Department of Infectious Diseases, Caen University Hospital, Caen, France
| | - Béatrice Le Maitre
- 4 Department of Smoking Cessation, Caen University Hospital, Caen, France
| | - Renaud Verdon
- 2 Department of Infectious Diseases, Caen University Hospital, Caen, France
- 3 EA 2656, Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Caen Normandie Université, Caen, France
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Grabovac I, Brath H, Schalk H, Degen O, Dorner TE. Clinical setting-based smoking cessation programme and the quality of life in people living with HIV in Austria and Germany. Qual Life Res 2017; 26:2387-2395. [PMID: 28429240 PMCID: PMC5548958 DOI: 10.1007/s11136-017-1580-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2017] [Indexed: 11/24/2022]
Abstract
Purpose To report on the global quality of life (QOL) in people living with HIV (PLWHIV) and how a smoking cessation intervention influences the changes in QOL. Methods Participants were asked to fill out a questionnaire during visits to their HIV outpatient clinic consisting of sociodemographic information, general health data and the WHOQOL HIV-Bref. Exhaled carbon monoxide measurements were used to confirm the smoking status, based on which participants classified as smokers received a short 5 min structured intervention and were offered participation in a full smoking cessation programme consisting of five sessions. Follow-up was done 8 months after the baseline. Results Overall 447 (mean age = 45.5) participants took part with 221 being classified as smokers. A total of 165 (74.6%) participants received a short intervention and 63 (29.4%) agreed to participate in the full program. At baseline, differences in QoL were observed, where smokers had lower QoL in domains of physical (M = 16.1 vs. 15.3, p = 0.009) and psychological (M = 15.3 vs. 14.6, p = 0.021) well-being, independency level (M = 16.1 vs. 15.2, p = 0.003) and environment (M = 16.5 vs. 16.0, p = 0.036). At study end, 27 (12.2%) participants quit smoking; 12 (19.0%) participants of the full programme and 15 (14.7%) that received the short intervention. There were no significant differences in QoL between those that continued to smoke and quitters at follow-up. Conclusion Quality of life results may be used to better understand the underlying motivation of PLWHIV who start cessation programs. In order to reduce the high prevalence and health burden that smoking causes in PLWHIV, it is necessary to introduce effective interventions that can be used in the clinical settings.
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Affiliation(s)
- Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
| | - Helmut Brath
- Health Centre South, Wienerbergstrasse 13, 1100, Vienna, Austria
| | - Horst Schalk
- "Schalk-Pichler Group Practice", Zimmermannplatz 1, 1090, Vienna, Austria
| | - Olaf Degen
- Infectious Diseases Unit, University Clinic Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Thomas E Dorner
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
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Weinberger AH, Smith PH, Funk AP, Rabin S, Shuter J. Sex Differences in Tobacco Use Among Persons Living With HIV/AIDS: A Systematic Review and Meta-Analysis. J Acquir Immune Defic Syndr 2017; 74:439-453. [PMID: 28002182 PMCID: PMC5321840 DOI: 10.1097/qai.0000000000001279] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Persons living with HIV/AIDS (PLWH) smoke at higher rates than other adults and experience HIV-related and non-HIV-related adverse smoking consequences. This study conducted a systematic review to synthesize current knowledge about sex differences in smoking behaviors among PLWH. METHODS Over 3000 abstracts from MEDLINE were reviewed and 79 publications met all the review inclusion criteria (ie, reported data on smoking behaviors for PLWH by sex). Sufficient data were available to conduct a meta-analysis for one smoking variable: current smoking prevalence. RESULTS Across studies (n = 51), the meta-analytic prevalence of current smoking among female PLWH was 36.3% (95% confidence interval [CI]: 28.0% to 45.4%) and male PLWH was 50.3% (95% CI: 44.4% to 56.2%; meta-analytic odds ratio = 1.78, 95% CI: 1.29 to 2.45). When analyses were repeated just on the US studies (n = 23), the prevalence of current smoking was not significantly different for female PLWH (55.1%, 95% CI: 47.6% to 62.5%) compared with male PLWH (55.5%, 95% CI: 48.2% to 62.5%; meta-analytic odds ratio = 1.04, 95% CI: 0.86 to 1.26). Few studies reported data by sex for other smoking variables (eg, quit attempts, noncigarette tobacco product use) and results for many variables were mixed. DISCUSSION Unlike the general US population, there was no difference in smoking prevalence for female versus male PLWH (both >50%) indicating that HIV infection status was associated with a greater relative increase in smoking for women than men. More research is needed in all areas of smoking behavior of PLWH to understand similarities and differences by sex to provide the best interventions to reduce the high smoking prevalence for all sexes.
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Affiliation(s)
- Andrea H Weinberger
- *Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY; †Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY; ‡Department of Community Health and Social Medicine, CUNY School of Medicine, New York, NY; §Department of Psychology, Hofstra University, Hempstead, NY; ‖Stern College for Women, Yeshiva University, New York, NY; and ¶AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY
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Lee PN, Fariss MW. A systematic review of possible serious adverse health effects of nicotine replacement therapy. Arch Toxicol 2017; 91:1565-1594. [PMID: 27699443 PMCID: PMC5364244 DOI: 10.1007/s00204-016-1856-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/22/2016] [Indexed: 12/11/2022]
Abstract
We conducted a systematic literature review to identify and critically evaluate studies of serious adverse health effects (SAHEs) in humans using nicotine replacement therapy (NRT) products. Serious adverse health effects refer to adverse events, leading to substantial disruption of the ability to conduct normal life functions. Strength of evidence evaluations and conclusions were also determined for the identified SAHEs. We evaluated 34 epidemiological studies and clinical trials, relating NRT use to cancer, reproduction/development, CVD, stroke and/or other SAHEs in patients, and four meta-analyses on effects in healthy populations. The overall evidence suffers from many limitations, the most significant being the short-term exposure (≤12 weeks) and follow-up to NRT product use in most of the studies, the common failure to account for changes in smoking behaviour following NRT use, and the sparse information on SAHEs by type of NRT product used. The only SAHE from NRT exposure we identified was an increase in respiratory congenital abnormalities reported in one study. Limited evidence indicated a lack of effect between NRT exposure and SAHEs for CVD and various reproduction/developmental endpoints. For cancer, stroke and other SAHEs, the evidence was inadequate to demonstrate any association with NRT use. Our conclusions agree with recent statements from authoritative bodies.
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Affiliation(s)
- Peter N. Lee
- P N Lee Statistics and Computing Ltd, 17 Cedar Road, Sutton, Surrey SM2 5DA UK
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Cigarette Smokers are Less Likely to Have Undetectable Viral Loads: Results From Four HIV Clinics. J Addict Med 2016; 10:13-9. [PMID: 26656939 DOI: 10.1097/adm.0000000000000172] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The prevalence of smoking among HIV-infected individuals is 2-3 times that of the general population, increasing the risk of smoking-related morbidity and mortality. We examined characteristics associated with smoking behavior among a large cohort of HIV-infected individuals in care in the United States. METHODS A convenience sample of 2952 HIV-infected patients in the Centers for AIDS Research (CFAR) Network of Integrated Clinical Systems (CNICS) was assessed during routine clinic visits and was included. Multinomial logistic regression was used to examine the relationship between smoking status, depression/panic symptoms, alcohol/substance use, and demographic and clinical characteristics. RESULTS Compared with never-smokers, current smokers were more likely to have moderate to severe depression (odds ratio [OR] 1.37), endorse current substance use (OR 14.09), and less likely to report low-risk alcohol use on the Alcohol Use Disorders Identification Test (AUDIT-C) (OR 0.73). Current smokers were less likely to have an undetectable viral load (OR 0.75), and more likely to have current substance abuse (OR 2.81) and moderate to severe depression (OR 1.50), relative to smokers who had quit smoking. CONCLUSIONS HIV-infected smokers are less likely to have undetectable viral loads and frequently have psychosocial comorbidities including depression and substance abuse that impact antiretroviral therapy adherence and viral load suppression. To be effective, smoking-cessation interventions need to address the complex underlying concurrent risks in this population.
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Pool ERM, Dogar O, Lindsay RP, Weatherburn P, Siddiqi K. Interventions for tobacco use cessation in people living with HIV and AIDS. Cochrane Database Syst Rev 2016; 2016:CD011120. [PMID: 27292836 PMCID: PMC8604206 DOI: 10.1002/14651858.cd011120.pub2] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality. OBJECTIVES To assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases. SELECTION CRITERIA Controlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA. DATA COLLECTION AND ANALYSIS Two review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria. MAIN RESULTS We identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I(2) = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I(2) = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study. AUTHORS' CONCLUSIONS There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.
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Affiliation(s)
- Erica RM Pool
- Brighton and Sussex University Hospitals NHS TrustBrightonUK
| | - Omara Dogar
- University of YorkDepartment of Health SciencesSeebohm Rowntree BuildingHeslingtonYorkUKYO10 5DD
| | - Ryan P Lindsay
- Idaho State UniversityDepartment of Community and Public HealthMeridianIdahoUSA
| | - Peter Weatherburn
- London School of Hygiene and Tropical MedicineSigma Research, Department of Social & Environmental Health ResearchLondonUK
| | - Kamran Siddiqi
- York UniversityDepartment of Health Sciences/Hull York Medical SchoolYorkUKYO10 5DD
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Ledgerwood DM, Yskes R. Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis. Nicotine Tob Res 2016; 18:2177-2184. [PMID: 27245237 DOI: 10.1093/ntr/ntw126] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/22/2016] [Indexed: 01/26/2023]
Abstract
INTRODUCTION People living with HIV/AIDS (PLWHA) are more likely to smoke cigarettes than are individuals in the general population. The health implications of tobacco use are substantially more dire among PLWHA than among otherwise healthy smokers, including higher rates of various cancers, cardiovascular disease, inflammation, and lung infections. Efficacious behavioral and medication treatments for treating nicotine dependence have rarely been investigated in PLWHA. METHODS We present a review of studies examining the efficacy of smoking cessation interventions. RESULTS AND CONCLUSIONS The literature reveals some limited evidence for the efficacy of behavioral interventions. However, the research literature on these interventions is sparse and the efficacy findings are mixed. Studies exploring the use of mobile technologies for reducing treatment barriers are becoming more prevalent. Few published trials have directly examined the efficacy of pharmacological smoking cessation interventions among PLWHA. Specific gaps in the treatment literature are discussed in detail, and a strategy is presented for developing a greater understanding of factors that contribute to the efficacy of smoking cessation among PLWHA. IMPLICATIONS This paper provides the most comprehensive review to date on smoking cessation intervention research conducted with PLWHA. It also discusses specific gaps in the literature that should be a priority for future research.
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Affiliation(s)
- David M Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
| | - Russell Yskes
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
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Determinants of Smoking and Quitting in HIV-Infected Individuals. PLoS One 2016; 11:e0153103. [PMID: 27099932 PMCID: PMC4839777 DOI: 10.1371/journal.pone.0153103] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 03/23/2016] [Indexed: 12/30/2022] Open
Abstract
Background Cigarette smoking is widespread among HIV-infected patients, who confront increased risk of smoking-related co-morbidities. The effects of HIV infection and HIV-related variables on smoking and smoking cessation are incompletely understood. We investigated the correlates of smoking and quitting in an HIV-infected cohort using a validated natural language processor to determine smoking status. Method We developed and validated an algorithm using natural language processing (NLP) to ascertain smoking status from electronic health record data. The algorithm was applied to records for a cohort of 3487 HIV-infected from a large health care system in Boston, USA, and 9446 uninfected control patients matched 3:1 on age, gender, race and clinical encounters. NLP was used to identify and classify smoking-related portions of free-text notes. These classifications were combined into patient-year smoking status and used to classify patients as ever versus never smokers and current smokers versus non-smokers. Generalized linear models were used to assess associations of HIV with 3 outcomes, ever smoking, current smoking, and current smoking in analyses limited to ever smokers (persistent smoking), while adjusting for demographics, cardiovascular risk factors, and psychiatric illness. Analyses were repeated within the HIV cohort, with the addition of CD4 cell count and HIV viral load to assess associations of these HIV-related factors with the smoking outcomes. Results Using the natural language processing algorithm to assign annual smoking status yielded sensitivity of 92.4, specificity of 86.2, and AUC of 0.89 (95% confidence interval [CI] 0.88–0.91). Ever and current smoking were more common in HIV-infected patients than controls (54% vs. 44% and 42% vs. 30%, respectively, both P<0.001). In multivariate models HIV was independently associated with ever smoking (adjusted rate ratio [ARR] 1.18, 95% CI 1.13–1.24, P <0.001), current smoking (ARR 1.33, 95% CI 1.25–1.40, P<0.001), and persistent smoking (ARR 1.11, 95% CI 1.07–1.15, P<0.001). Within the HIV cohort, having a detectable HIV RNA was significantly associated with all three smoking outcomes. Conclusions HIV was independently associated with both smoking and not quitting smoking, using a novel algorithm to ascertain smoking status from electronic health record data and accounting for multiple confounding clinical factors. Further research is needed to identify HIV-related barriers to smoking cessation and develop aggressive interventions specific to HIV-infected patients.
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Brath H, Grabovac I, Schalk H, Degen O, Dorner TE. Prevalence and Correlates of Smoking and Readiness to Quit Smoking in People Living with HIV in Austria and Germany. PLoS One 2016; 11:e0150553. [PMID: 26919722 PMCID: PMC4771118 DOI: 10.1371/journal.pone.0150553] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 02/15/2016] [Indexed: 12/21/2022] Open
Abstract
We aimed to investigate the prevalence and correlates of smoking in people living with HIV (PLWHIV) in Germany and Austria and their readiness to quit. A total of 447 consecutive patients with confirmed positive HIV status who were treated in different outpatient HIV centres in Austria and Germany were included. Nicotine dependence and stages of change were assessed by standardized questionnaires, and this was confirmed by measuring exhaled carbon monoxide. Prevalence of smoking was 49.4%. According to a multivariate logistic regression analysis, higher age (for each year of life OR = 0.96; 95% CI 0.92–1.00) and tertiary education level (OR = 0.43; 95% CI 0.15–0.79) were associated with a lower chance, and occasional (OR = 3.75; 95% CI 1.74–8.07) and daily smoking of the partner (OR 8.78; 95% CI 4.49–17.17) were significantly associated with a higher chance of smoking. Moderate (OR = 3.41; 95% CI = 1.30–9.05) and higher nicotine dependency level (OR = 3.40; 95% CI 1.46–7.94), were significantly associated with higher chance, and older age (for each year of life OR = 0.95; 95% CI = 0.91–0.99), with lower chance for readiness to quit smoking. Those results may be used to address preventive measures to quit smoking aimed at PLWHIV and the importance of addressing smoking habits.
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Affiliation(s)
| | - Igor Grabovac
- Institute of Occupational Medicine, University Clinic for Internal Medicine II, Medical University of Vienna, Vienna, Austria
- * E-mail:
| | | | - Olaf Degen
- University Clinic Hamburg-Eppendorf, Outpatient Centre, Hamburg, Germany
| | - Thomas E. Dorner
- Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
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Rojewski AM, Baldassarri S, Cooperman NA, Gritz ER, Leone FT, Piper ME, Toll BA, Warren GW. Exploring Issues of Comorbid Conditions in People Who Smoke. Nicotine Tob Res 2016; 18:1684-96. [PMID: 26783291 DOI: 10.1093/ntr/ntw016] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 01/06/2016] [Indexed: 01/21/2023]
Abstract
UNLABELLED Smoking affects comorbid disease outcomes, and patients with comorbid conditions may have unique characteristics that are important to consider when treating tobacco use. However, addressing tobacco in patients being treated for comorbid conditions is not a consistent practice. Recognizing the need for a "call-to-action" to address tobacco use in people with comorbid conditions, the Tobacco Treatment Network within the Society for Research on Nicotine and Tobacco (SRNT) convened a Comorbidities Workgroup to explore the relationship between smoking and comorbid disease to identify common themes including: the harms associated with continued tobacco use, the frequency of comorbid disease and tobacco use, the potential effect of comorbid disease on the ability to quit tobacco use, the association between tobacco use and suboptimal disease-specific treatment response, and evidence regarding potential approaches to improve addressing tobacco use in patients with comorbid disease. Five candidate conditions (psychiatric, cancer, cardiovascular, pulmonary, and human immunodeficiency virus infected patients) were explored. Across comorbid conditions, smoking adversely affects treatment efficacy and promotes other adverse health conditions. People with comorbid conditions who smoke are motivated to quit and respond to evidence-based smoking cessation treatments. However, tobacco cessation is not regularly incorporated into the clinical care of many individuals with comorbidities. Optimal strategies for addressing tobacco use within each comorbid disease are also not well defined. Further work is needed to disseminate evidence-based care into clinical practice for smokers with comorbid disease and addiction research should consider comorbid conditions as an important construct to explore. IMPLICATIONS This article explores how physical and psychiatric conditions may interact in the treatment of tobacco dependence, and discusses the need for smoking cessation as a critical component of comorbid condition management. Five common comorbid domains-psychiatric, cancer, pulmonary, cardiovascular, and human immunodeficiency virus (HIV)-are highlighted to illustrate how these different conditions might interact with smoking with respect to prevalence and harm, motivation to quit, and cessation treatment utilization and success.
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Affiliation(s)
- Alana M Rojewski
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Stephen Baldassarri
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT
| | - Nina A Cooperman
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, Piscataway, NJ; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ellen R Gritz
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Frank T Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, Philadelphia, PA
| | - Megan E Piper
- Center for Tobacco Research and Intervention, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Benjamin A Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT; Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC; Department of Cancer Prevention and Control, Yale Cancer Center, New Haven, CT; Tobacco Treatment Service, Smilow Cancer Hospital at Yale-New Haven, New Haven, CT; Tobacco Treatment and Lung Cancer Screening Programs, Hollings Cancer Center, Charleston, SC
| | - Graham W Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC; Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
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Calvo-Sánchez M, Martinez E. How to address smoking cessation in HIV patients. HIV Med 2014; 16:201-10. [PMID: 25296689 DOI: 10.1111/hiv.12193] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2014] [Indexed: 01/13/2023]
Abstract
Tobacco consumption is the modifiable risk factor contributing most to the development of non-AIDS-defining events among persons living with HIV/AIDS (PLWHA). Clinicians' awareness of this problem is critical and not yet adequate. Practical information issued by public health authorities or contained in experts' clinical guidelines regarding how to address smoking cessation in PLWHA is scarce. The aim of this review is to provide physicians with comprehensive and practical information regarding how to identify HIV-positive patients willing to stop smoking and those more likely to succeed, how to choose the most suitable strategy for an individual patient, and how to help the patient during the process. In the light of current evidence on the efficacy and benefits of stopping smoking in PLWHA, physicians must actively pursue smoking cessation as a major objective in the clinical care of PLWHA.
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Affiliation(s)
- M Calvo-Sánchez
- Infectious Diseases, Hospital Clinic-IDIBAPS, Barcelona, Spain; Infectious Diseases, Universitäts Klinikum Bonn, Bonn, Germany
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Evaluation of a Smoking Cessation Program for HIV Infected Individuals in an Urban HIV Clinic: Challenges and Lessons Learned. AIDS Res Treat 2014; 2014:237834. [PMID: 25349726 PMCID: PMC4198817 DOI: 10.1155/2014/237834] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 09/13/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. HIV infected persons have high prevalence of smoking and tobacco-associated health risks. Few studies describe smoking cessation programs targeting this population. The Infectious Disease Practice (IDP) in Newark, New Jersey, initiated a smoking cessation program (SCP) for HIV infected smokers. We report participation, abstinence rates, and predictors of abstinence. Methods. This is a prospective cohort study, comparing participants to non-SCP smokers, during April 1, 2011, to October 31, 2012. Intervention included one individualized counseling session with an offer of pharmacotherapy. Univariate and multivariate analyses were performed with self-reported seven-day point prevalence abstinence at six months as primary outcome measure. Results. Among 1545 IDP patients, 774 (51%) were current smokers of whom 123 (16%) participated in the SCP. Mean six-month abstinence rate amongst SCP participants was 16%. A history of cocaine or heroin use was predictive of continued smoking (odds ratio [OR] adjusted 0.20, 95% confidence interval [CI] 0.07-0.55) while smokers in the preparation stage of change were more likely abstinent at six months (OR adjusted 8.26, 95% CI 1.02-66.67). Conclusions. A low-intensity smoking cessation intervention in an HIV treatment setting is effective in a minority of participants. Further research is needed to better address barriers to smoking cessation such as substance use.
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Lifson AR, Neuhaus J, Arribas JR, van den Berg-Wolf M, Labriola AM, Read TRH. Smoking-related health risks among persons with HIV in the Strategies for Management of Antiretroviral Therapy clinical trial. Am J Public Health 2010; 100:1896-903. [PMID: 20724677 DOI: 10.2105/ajph.2009.188664] [Citation(s) in RCA: 217] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We sought to determine smoking-related hazard ratios (HRs) and population-attributable risk percentage (PAR%) for serious clinical events and death among HIV-positive persons, whose smoking prevalence is higher than in the general population. METHODS For 5472 HIV-infected persons enrolled from 33 countries in the Strategies for Management of Antiretroviral Therapy clinical trial, we evaluated the relationship between baseline smoking status and development of AIDS-related or serious non-AIDS events and overall mortality. RESULTS Among all participants, 40.5% were current smokers and 24.8% were former smokers. Adjusted HRs were higher for current than for never smokers for overall mortality (2.4; P < .001), major cardiovascular disease (2.0; P = .002), non-AIDS cancer (1.8; P = .008), and bacterial pneumonia (2.3; P < .001). Adjusted HRs also were significantly higher for these outcomes among current than among former smokers. The PAR% for current versus former and never smokers combined was 24.3% for overall mortality, 25.3% for major cardiovascular disease, 30.6% for non-AIDS cancer, and 25.4% for bacterial pneumonia. CONCLUSIONS Smoking contributes to substantial morbidity and mortality in this HIV-infected population. Providers should routinely integrate smoking cessation programs into HIV health care.
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Affiliation(s)
- Alan R Lifson
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55454-1015, USA.
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Nahvi S, Cooperman NA. Review: the need for smoking cessation among HIV-positive smokers. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2009; 21:14-27. [PMID: 19537951 PMCID: PMC2704483 DOI: 10.1521/aeap.2009.21.3_supp.14] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Most HIV-positive persons in the U.S. smoke cigarettes. Despite substantial clinical advances in HIV care in the era of highly active antiretroviral therapy (HAART), HIV-positive persons are at high risk of tobacco-related disease and death. HIV-positive persons have complex social, economic, psychiatric, and medical needs that may impact smoking behavior and response to smoking cessation interventions, but there is a dearth of research on smoking cessation interventions tailored to HIV-positive persons. HIV care providers should treat tobacco use with the array of evidence-based smoking cessation treatments available, updating their clinical practice as new data emerge. This article reviews the literature on the health consequences of tobacco use in HIV-positive persons, the treatment of tobacco dependence, and the research to date on smoking cessation interventions in HIV-positive persons, and it presents recommendations for future research and intervention.
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Affiliation(s)
- Shadi Nahvi
- Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center, 111 East 210 thSt. Bronx, NY 10467, USA.
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Vidrine DJ. Cigarette smoking and HIV/AIDS: health implications, smoker characteristics and cessation strategies. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2009; 21:3-13. [PMID: 19537950 PMCID: PMC6698157 DOI: 10.1521/aeap.2009.21.3_supp.3] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Although mortality attributable to AIDS-related diseases has decreased dramatically in the current era of combination antiretroviral therapy, the proportion of deaths attributable to other diseases (e.g., cardiovascular, pulmonary, and cancer) in this population has markedly increased. Thus, efforts to reduce morbidity and mortality attributable to these non-AIDS-defining diseases represent an important public health priority. One approach to improve health outcomes for the HIV-positive population is to target health risk behaviors, such as cigarette smoking. Existing evidence indicates that smoking prevalence is significantly elevated among persons living with HIV/AIDS. In addition, smoking is associated with numerous HIV-related adverse outcomes. To date, surprisingly few efforts have been made to develop smoking cessation interventions for the HIV-positive population. However, results from the studies that have been published indicate that smoking cessation interventions, both novel and more traditional, are potentially efficacious. Moreover, existing findings support the feasibility of smoking cessation treatment within busy HIV clinics.
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Affiliation(s)
- Damon J Vidrine
- Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, USA.
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