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.

项目概要 吸烟对艾滋病毒感染者的不良健康影响是深远且有效的治疗方法 长期戒烟仍然难以实现，迫切需要解决患者障碍的干预措施。 戒烟和有效治疗广泛异质吸烟者群体的临床障碍 HIV (SLWH) 本研究的长期目标是通过提供优化的治疗方案来改善 SLWH 的临床结果。 HIV 临床护理中的戒烟干预措施 该提案将使用多阶段优化策略。 (MOST) 测试旨在消除 SLWH 戒烟障碍的四项干预措施，目的是 选择一套具有成本效益、可持续、可扩展的艾滋病毒戒烟方案 组成部分包括： 动机访谈（关/开）；同伴指导（关/开）； （关/开）；伐尼克兰或联合尼古丁替代疗法（关/开）已显示这些成分。 在研究中有希望，但未充分利用来帮助 SLWH 戒烟，并且尚未在优化试验中进行测试。 所提出的 MOST 因子优化试验是一种估计主效应的高效方法 该方法解决了每个干预组件的贡献以及组件之间的所有相互作用。 先前研究的弱点，无法评估各个组成部分的贡献 该提案还将包括对实施过程的严格评估。 以及对干预措施实施、可持续性和促进因素的障碍和促进因素进行理论驱动的评估 HIV 临床护理的可扩展性 目标包括： (1) 评估四种戒烟干预措施的有效性。 通过进行高效的因子优化试验，研究 SLWH 长期禁欲的组成部分 （即 MOST）在 HIV 临床护理中投入 500 SLWH (2) 评估成本和实施过程，包括 影响艾滋病毒护理机构中戒烟治疗的可持续性和可扩展性潜力的因素 以 Proctor 的实施成果框架和综合框架为指导。 实施研究，我们将收集有关覆盖范围、保真度、可接受性和 (3) 确定优化干预措施 通过进行创新的多标准决策分析来选择四个组件的子集 实现了最高水平的成本效益，并且在艾滋病毒临床护理工作中具有可扩展性和可持续性。 与最大的市公共医疗保健系统纽约市健康与医院 (H+H) 合作 在美国，以及一支在干预优化、戒烟和艾滋病毒/艾滋病方面拥有无与伦比的专业知识的团队， 这项拟议的研究直接响应了美国国家癌症研究所 (NCI) 对吸烟研究的呼吁 “优化干预措施的有效性、实施和可持续性。” 重大公共卫生影响，并通过为进一步改进提供明确的基础来丰富科学知识 未来研究中对 SLWH 的戒烟干预措施。