Development, Implementation, and Evaluation of a Tobacco Cessation Intervention Tailored to Persons Living with HIV (PLWH) in Brazil: A Feasibility Study

巴西针对艾滋病毒感染者 (PLWH) 的戒烟干预措施的制定、实施和评估：可行性研究

• 批准号: 10079146
• 负责人: ISABEL C SCARINCI
• 金额: $ 16.81万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10079146
• 关键词: Abstinence; Address; Adoption; Behavior; Brazil; Carbon Monoxide; Caring; Clinic; Clinical; Cognitive Therapy; Collaborations; Cotinine; Counseling; Country; Data; Development; Diagnosis; Dimensions; Enrollment; Evaluation; Evidence based treatment; Exhalation; Exposure to; Feasibility Studies; Feedback; General Population; Goals; HIV; HIV/TB; Health; Health Personnel; Health system; High Prevalence; Individual; Intervention; Interview; Literature; Maintenance; Manuscripts; Measurement; Medication Management; Modality; Modification; Monitor; Moods; Nurses; Participant; Patient Recruitments; Patients; Persons; Pharmacology; Pharmacotherapy; Physicians; Population; Population Heterogeneity; Positioning Attribute; Preparation; Prevalence; Primary Health Care; Process; Provider; Pseudonym; Psychologist; Public Health; Salivary; Services; Site; Smoker; Social support; Stress; Structure; Subgroup; Suggestion; Support Groups; Testing; Text Messaging; Therapeutic Intervention; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Tuberculosis; Underserved Population; Work; base; behavioral pharmacology; cost; design; efficacy evaluation; efficacy trial; evidence base; experience; follow-up; formative assessment; group intervention; health disparity; interest; intersectionality; literacy; low and middle-income countries; primary outcome; programs; prospective; randomized trial; social; social cognitive theory; theories; therapy development; tobacco cessation intervention; tobacco user; treatment trial; virtual

Abstract Persons Living with HIV (PLWH) are considered an underserved population with regard to tobacco cessation given the high prevalence of tobacco use compared to the general population and the lack of evidence-based tobacco cessation programs tailored to PLWH, particularly in low- and middle-income countries (LMICs). Although it has been well established that a combination of cognitive behavioral therapy (CBT) and pharmacological management is efficacious in promoting tobacco cessation across diverse populations, these evidence-based treatments have not proven to be effective/efficacious (or even accessible) among these patients. Our preliminary data among PLWH with or without a prior/current diagnosis of tuberculosis attending the public health system in Brazil identified multiple barriers faced by this population with regard to tobacco cessation, including limited literacy, habitual behavior, tobacco use as mood management, lack of social support, cost, distance to care, and reluctance to attend the available tobacco cessation program offered through the primary care clinics due to confidentiality concerns. The overall goal of this feasibility study is to make adaptations to these evidence-based approaches in collaboration with PLWH and health care providers working with this population, and develop, implement, and evaluate the feasibility and scalability of a theory- based, culturally relevant tobacco cessation intervention for PLWH receiving care through the public health system in a southern town in Brazil (Londrina). Our formative assessments point to a mixed approach: CBT (delivered by a Clinical Psychologist) + pharmacotherapy (delivered by a Pulmonologist) augmented by a virtual social support group. This proposal will focus on the intervention development, pretesting, and feasibility testing. The primary outcome will be a 7-day point prevalence abstinence (defined as no tobacco use in the past 7 days and verified through measurement of salivary cotinine and exhaled carbon monoxide levels) at 6- month follow-up. We will also conduct detailed treatment fidelity and scalability assessments (acceptability, feasibility, potential reach and adoption, alignment with the strategic context) to inform a full-scale efficacy trial.

抽象的 艾滋病毒（PLWH）的人被认为是服务不足的人群 鉴于与普通人群相比，烟草使用率很高，缺乏循证 量身定制的烟草戒烟计划，特别是在低收入和中等收入国家（LMIC）。 尽管已经很好地确定了认知行为疗法（CBT）和 药理学管理有效地促进跨不同人群的烟草戒烟，这些 基于证据的治疗尚未被证明是有效/有效的（甚至可以访问） 患者。我们在PLWH中的初步数据，有或没有先验/当前的结核病诊断 巴西的公共卫生系统确定了该人群在烟草方面面临的多个障碍 停止，包括有限的识字，习惯行为，烟草用作情绪管理，缺乏社会 支持，成本，护理距离和不愿参加提供的可用戒烟计划 由于保密问题，通过初级保健诊所。这项可行性研究的总体目标是 与PLWH和医疗保健提供者合作，适应这些基于证据的方法 与该人群合作，并发展，实施和评估理论的可行性和可伸缩性 - 基于公共卫生的基于文化相关的烟草戒烟干预措施 巴西南部城镇（隆德里纳）的系统。我们的形成性评估指出了一种混合方法：CBT （由临床心理学家提供） +药物治疗（由肺科医生提供） 虚拟社会支持小组。该提案将重点介绍干预开发，预测试和可行性 测试。主要结果将是7天的戒酒率（定义为在 过去的7天，通过测量唾液可替氨酸和呼出的一氧化碳水平来验证） 一个月随访。我们还将进行详细的治疗保真度和可伸缩性评估（可接受性， 可行性，潜在的覆盖范围和采用，与战略环境保持一致），以告知全面效力试验。