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 艾滋病毒感染者 (PLWH) 被认为是戒烟服务不足的人群 鉴于与一般人群相比，烟草使用率较高且缺乏基于证据的证据 针对 PLWH 的戒烟计划，特别是在低收入和中等收入国家 (LMIC)。 尽管认知行为疗法（CBT）和 药物管理可有效促进不同人群的戒烟，这些 在这些治疗中，基于证据的治疗尚未被证明是有效的/有效的（甚至是可获得的） 患者。我们在先前/当前诊断出结核病的 PLWH 中的初步数据 巴西的公共卫生系统发现了该人群在烟草方面面临的多重障碍 戒烟，包括识字能力有限、习惯性行为、使用烟草作为情绪管理、缺乏社交 支持、费用、护理距离以及不愿意参加所提供的戒烟计划 出于保密考虑，通过初级保健诊所进行。本次可行性研究的总体目标是 与艾滋病患者和卫生保健提供者合作，适应这些循证方法 与这一人群合作，开发、实施和评估理论的可行性和可扩展性—— 针对通过公共卫生部门接受护理的感染者进行基于文化的相关戒烟干预 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），辅以药物治疗 虚拟社会支持小组。该提案将重点关注干预措施的开发、预测试和可行性 测试。主要结果将是 7 天点戒烟流行率（定义为在 过去 7 天，并通过测量唾液可替宁和呼出的一氧化碳水平进行验证）在 6- 月随访。我们还将进行详细的处理保真度和可扩展性评估（可接受性、 可行性、潜在影响力和采用率、与战略背景的一致性）为全面的功效试验提供信息。