Improving the Reach & Effectiveness of Smoking Cessation Services Targeted to Veterans Living with HIV
- Conditions
- Smoking CessationHIV InfectionsSmoking
- Interventions
- Behavioral: Wellness Intervention for Smokers with HIV
- Registration Number
- NCT04505371
- Brief Summary
This project will compare the effectiveness of an HIV-specific comprehensive wellness intervention designed to have broad appeal to smokers living with HIV to the effectiveness of standard care services that include referral to the National VA Quitline and SmokefreeVET texting program. Participants in both arms will have access to pharmacotherapy available through their Veterans Affairs (VA) healthcare providers.
- Detailed Description
Tobacco use remains the leading preventable cause of death and illness in our society, and smoking rates are disproportionately high among people living with HIV. NCI, nicotine dependence researchers, and HIV clinicians have all called for research to evaluate targeted and tailored smoking cessation programs for smokers living with HIV (SLWH). Research suggests SLWH are largely unaware of the HIV-specific deleterious effects of smoking and often lack motivation and confidence in their ability to quit. For these reasons, we developed the Wellness Intervention for Smokers with HIV (WISH).
Similar to standard care cessation services available to Veterans, WISH is delivered remotely by mobile phone (voice and text message). The program is designed for all SLWH, regardless of their initial motivation to quit. WISH follows evidence-based, best practice guidelines for nicotine dependence treatment, but is innovative in its use of a more comprehensive wellness approach. That is, the intervention addresses both smoking and a number of other personally relevant health behaviors (such as treatment engagement, medication adherence, stress and mood management, social support, alcohol use, etc.), making it relevant and engaging to all SLWH, not just those ready to stop smoking. For those not yet ready to quit, WISH is designed to build and strengthen motivation and self-confidence for quitting, while smokers also work on other personal health goals.
Once ready to quit smoking, participants receive evidence-based cognitive-behavioral counseling and encouragement to access nicotine replacement therapy (NRT) or other appropriate pharmacotherapy through usual care VA procedures. Medications will not be prescribed or dispensed by the study, allowing use of these standard services to be compared across study groups.
In this two-group randomized trial, we will compare the effectiveness of WISH to standard care services offered through the National VA Quitline and the SmokefreeVET texting program (tobacco cessation services available to all Veterans). Participants in both study groups can receive phone/ text counseling and have access to pharmacotherapy through VA. Cessation services in both study groups will be provided and overseen by the non-VA sites that developed each program.
Smoking-related outcomes will include 7-day point prevalence smoking abstinence and presence of any 24-hour intentional quit attempts, prolonged abstinence, and change in cigarettes per day. We will measure change in smoking-related knowledge, motivation and behavioral skills, as well as intervention reach and implementation. We will also describe comorbidities and explore intervention impact on markers of immune status and mortality risk using clinical data resources available through the Veterans Aging Cohort Study (VACS).
If effective, WISH could meaningfully increase the reach of cessation services and reduce smoking among HIV+ Veterans nationwide. To support this goal, dissemination efforts are planned in Year 5 to share the WISH program with the National VA Quitline. Because VA is the largest U.S. provider of HIV care, this research has the potential for significant public health impact.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 226
- In care in the VA
- HIV+ serostatus
- Currently smoking 5+ cigarettes daily
- Access to cell phone with text messaging capabilities
- English speaking
- Psychosis, dementia or significant cognitive impairment documented in the EHR
- Documented or observed hearing or comprehension difficulties that would preclude participation in study telephone calls
- Currently receiving cessation counseling or using an FDA approved treatment to quit smoking
- Institutionalized/imprisoned
- Pregnant
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention - Wellness Intervention for Smokers with HIV Wellness Intervention for Smokers with HIV The experimental WISH intervention is an HIV-specific comprehensive wellness program designed to offer integrated phone and text counseling regardless of readiness to quit.
- Primary Outcome Measures
Name Time Method Any 24-hour intentional quit attempt 3 and 6 months postrandomization The primary outcome will be presence of an intentional quit attempt \[yes/no\] reported between randomization and 6 month follow-up. Quit attempts will be assessed at each follow-up.
7-day point-prevalence abstinence (PPA) 6 months post-randomization Smoking abstinence at 6-month follow-up by self-report and biochemically confirmed via saliva cotinine for a small selected group of individuals. Cotinine levels \< 10 ng/ml and a self-report of 7 day PPA will be required to be coded a nonsmoker.
- Secondary Outcome Measures
Name Time Method Floating prolonged abstinence 3 and 6 months post-randomization A proxy for sustained abstinence appropriate for evaluating a motivational intervention, in which the start point floats based on one's actual quit date rather than a pre-determined quit date
HIV-specific smoking knowledge 3 and 6 months post-randomization Items validated in a survey of Smokers Living with HIV conducted by the study team during a study titled "Smoking cessation-related information, motivation, and behavioral skills specific to HIV-infected smokers" (likert scale)
Intentional quit attempt frequency and duration 3 and 6 months post-randomization Behavioral Risk Factor Surveillance System (BRFSS)
7-day self-report point-prevalence abstinence (PPA) 3 and 6 months post-randomization Self-report of abstinence from smoking, even a puff
30-day self-report point-prevalence abstinence (PPA) 3, 6, 12 months post-randomization Self-report of abstinence from smoking, even a puff
Smoking cessation related to self-efficacy 3 and 6 months post-randomization 1-10 likert scale on domains (each) of quitting smoking, reducing smoking, managing cravings, and stimulus control
Absolute CD4 count 6 and 12 months post-randomization Lab value of CD4 ascertained via EHR
VACS index 2.0 6 and 12 months post-randomization Composite score based of various lab values ascertained via EHR
Cigarettes smoked per day 3 and 6 months post-randomization Self-report; even a puff counts as smoking
Motivation to quit smoking 3 and 6 months post-randomization 1-10 likert scale
Nicotine withdrawal symptom management (behavioral skills) 3 and 6 months post-randomization Self-report Minnesota Smoking Withdrawal Scale, Revised
Cessation medication use and adherence (behavioral skills) 3 and 6 months post-randomization Self-report and health records (pharmacy) monitoring
Trial Locations
- Locations (1)
VA Puget Sound Health Care System Seattle Division
🇺🇸Seattle, Washington, United States