Using Multiphase Optimization Strategy (MOST) to Optimize a Cost-effective, Sustainable and Scalable Smoking Cessation Package for Smokers in HIV Clinical Care

使用多阶段优化策略 (MOST) 为 HIV 临床护理中的吸烟者优化具有成本效益、可持续且可扩展的戒烟方案

• 批准号: 10649607
• 负责人: Jennifer Cantrell
• 金额: $ 65.05万
• 依托单位: NEW YORK UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10649607
• 关键词: Abstinence; Acute; Address; Administrator; Affect; Biochemical; Caring; Cause of Death; Cessation of life; Clinical; Collaborations; Competence; Complex; Consolidated Framework for Implementation Research; Cost Analysis; Cost Measures; Counseling; Data; Decision Analysis; Disease; Economics; Effectiveness; Effectiveness of Interventions; Evaluation; Face; General Population; Goals; HIV; HIV/AIDS; Health; Health Personnel; Healthcare Systems; Hospitals; Individual; Internet; Intervention; Intervention Trial; Interview; Knowledge; Life; Longitudinal Studies; Measures; Medical; Methods; Motivation; Municipalities; National Cancer Institute; New York City; Nicotine Withdrawal; Outcome; Persons; Pharmacotherapy; Population; Population Heterogeneity; Prevalence; Process; Proctor framework; Professional counselor; Public Health; Readiness; Research; Resources; Risk; Services; Smoker; Smoking; Smoking Cessation Intervention; Social support; Structure; Surveys; Testing; Text Messaging; Time; Tobacco; Tobacco Use Cessation; Withdrawal; barrier to care; cigarette smoking; clinical care; comorbidity; cost; cost effective; cost effectiveness; effective therapy; effectiveness evaluation; evidence base; implementation intervention; implementation outcomes; implementation process; improved; innovation; interest; intervention cost; long term abstinence; motivational enhancement therapy; multi-component intervention; multiphase optimization strategy; nicotine replacement; non-smoker; patient-level barriers; peer coaching; premature; programs; risk perception; skills; smoking cessation; social stigma; theories; varenicline

Project Summary The adverse health impact of cigarette smoking on persons living with HIV is profound and effective treatments for long-term abstinence remain elusive. There is an acute need for interventions that address patient barriers to quitting and clinical barriers to effectively treating a broad heterogeneous population of smokers living with HIV (SLWH). This study’s long-term goal is to improve clinical outcomes among SLWH by providing optimized smoking cessation interventions in HIV clinical care. This proposal will use the Multiphase Optimization STrategy (MOST) to test four intervention components aimed at barriers to quitting among SLWH, with the objective of selecting the set that constitutes a cost-effective, sustainable, scalable smoking cessation package for HIV clinical care. Components include: Motivational Interviewing (Off/On); Peer Mentoring (Off/On); Text-messaging (Off/On); Varenicline or Combination Nicotine Replacement Therapy (Off/On). These components have shown promise in research but are under-utilized to help SLWH quit and have not been tested in an optimization trial. The proposed MOST factorial optimization trial is a highly efficient method for estimating the main effect contribution of each intervention component and all interactions between components. This approach addresses weaknesses in prior studies, which are not able to assess the contribution of individual components of multicomponent interventions. The proposal will also include a rigorous evaluation of the implementation process and theory-driven assessment of barriers to and facilitators of intervention implementation, sustainability and scalability in HIV clinical care. Aims include: (1) Assess the effectiveness of four smoking cessation intervention components on long-term abstinence among SLWH by conducting a highly efficient factorial optimization trial (i.e., MOST) with 500 SLWH in HIV clinical care. (2) Assess costs and the implementation process, including factors that affect the potential for sustainability and scalability of cessation treatment in HIV care settings serving SLWH. Guided by Proctor’s Implementation Outcomes Framework and the Consolidated Framework for Implementation Research, we will collect mixed methods data on reach, fidelity, acceptability and appropriateness among SLWH, stakeholders and study interventionists. (3) Identify the optimized intervention by conducting an innovative multi-criteria decision analysis to select the subset of the four components that achieves the highest level of cost-effectiveness and is both scalable and sustainable in HIV clinical care. Working in collaboration with New York City Health and Hospitals (H+H), the largest municipal public healthcare system in the U.S., and a team with unparalleled expertise in intervention optimization, smoking cessation and HIV/AIDS, the proposed study responds directly to the National Cancer Institute’s (NCI) call for smoking research that “optimizes intervention effectiveness, implementation and sustainability.” The optimized intervention will have a significant public health impact and add to scientific knowledge by providing a clear basis for further improvement of cessation interventions for SLWH in future research.

项目摘要 吸烟对艾滋病毒患者的不利健康影响是深刻而有效的治疗方法 长期禁欲仍然难以捉摸。急需干预措施解决患者障碍 安静而临床的障碍，有效地治疗与之相处的广泛的吸烟者 艾滋病毒（SLWH）。这项研究的长期目标是通过提供优化来改善SLWH的临床结果 在艾滋病毒临床护理中戒烟干预措施。该建议将使用多相优化策略 （大多数）测试针对SLWH之间退出障碍的四个干预组件，目的是 选择构成艾滋病毒的成本效益，可持续，可扩展的戒烟包的场景 临床护理。组件包括：动机访谈（OFF/ON）；同行指导（OFF/ON）；文字发音 （OFF/ON）； Varenicline或组合尼古丁替代疗法（OFF/ON）。这些组件已显示 在研究方面的承诺，但未能实现帮助SLWH退出，并且在优化试验中尚未进行测试。 拟议的大多数阶乘优化试验是估计主要效果的高效方法 每个干预组件的贡献以及组件之间的所有相互作用。这种方法解决了 先前研究的弱点，这些研究无法评估单个组件的贡献 多组分干预措施。该提案还将包括对实施过程的严格评估 以及理论驱动的对干预实施，可持续性和促进者的评估和促进者 HIV临床护理中的可伸缩性。目的包括：（1）评估四种戒烟干预的有效性 通过进行高效的阶乘优化试验，SLWH长期禁欲的组成部分 （即大多数）在HIV临床护理中有500 SLWH。 （2）评估成本和实施过程，包括 影响艾滋病毒护理环境中戒烟治疗的潜在可持续性和可扩展性的因素 Slwh。在Proctor的实施成果框架和合并框架的指导下 实施研究，我们将收集有关覆盖范围，忠诚，可接受性和的混合方法数据 SLWH，利益相关者和研究干预者之间的适当性。 （3）确定优化的干预措施 通过进行创新的多标准决策分析，以选择四个组成部分的子集 达到最高水平的成本效益，在HIV临床护理中既可扩展又可持续。在职的 最大的文化公共卫生系统与纽约市健康与医院（H+H）合作 在美国，以及一个在干预优化，戒烟和艾滋病毒/艾滋病方面拥有无与伦比专业知识的团队， 拟议的研究直接回应了国家癌症研究所（NCI）的吸烟研究呼吁 “优化干预效率，实施和可持续性。”优化的干预措施将有一个 通过为进一步改进的明确依据提供明确的基础，公共卫生的重大影响并增加了科学知识 未来研究中SLWH的戒烟干预措施。