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A Randomized Controlled Trial of a Tailored Group Smoking Cessation Intervention for HIV-Infected Smokers

Moadel, Alyson B. PhD*; Bernstein, Steven L. MD; Mermelstein, Robin J. PhD; Arnsten, Julia H. MD, MPH§; Dolce, Eileen H. PA; Shuter, Jonathan MD

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1st, 2012 - Volume 61 - Issue 2 - p 208–215
doi: 10.1097/QAI.0b013e3182645679
Clinical Science

Background: More than half of the persons living with human immunodeficiency virus (HIV; PLWH) in the US smoke cigarettes, and tobacco use is responsible for considerable morbidity and mortality in this group. Little is known about the efficacy of tobacco treatment strategies in PLWH.

Design: Randomized controlled trial comparing Positively Smoke Free (PSF), an intensive group-therapy intervention targeting HIV-infected smokers, to standard care.

Methods: A cohort of 145 PLWH smokers, recruited from an HIV-care center in the Bronx, New York, were randomized 1:1 into the PSF program or standard care. All were offered a 3-month supply of nicotine replacement therapy. PSF is an 8-session program tailored to address the needs and concerns of HIV-infected smokers. The sessions were cofacilitated by a graduate student and an HIV-infected peer. The primary outcome was biochemically confirmed, 7-day point-prevalence abstinence at 3 months.

Results: In the intention-to-treat analysis, PSF condition subjects had nearly double the quit rate of controls (19.2% vs. 9.7%, P = 0.11). In the complete case, as-treated analysis, assignment to PSF was associated with increased odds of quitting (odds ratioadj 3.55, 95% confidence interval 1.04 to 12.0). Latino ethnicity and lower loneliness score were predictive of abstinence. The subjects in the PSF condition exhibited significant decreases in daily cigarette consumption and significant increases in self-efficacy and in motivation to quit. Attendance of ≥7 sessions was associated with higher quit rates.

Conclusions: These findings suggest a positive effect of PSF on cessation rates in PLWH smokers. Loneliness and self-efficacy are influential factors in the smoking behaviors of PLWH.

*Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Albert Einstein Cancer Center, Bronx, NY

Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT

Department of Psychology, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL

§Department of Medicine, Division of General Internal Medicine, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY

Department of Medicine, AIDS Center and Division of Infectious Diseases, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY.

Correspondence to: Jonathan Shuter, MD, Montefiore Medical Center AIDS Center, 111 E 210th Street, Bronx, NY 10467, 718-920-7845 (o), (e-mail: jshuter@montefiore.org).

Supported by grant R21 DA023362 from the National Institutes of Health/National Institute on Drug Abuse. It was also supported by the Clinical Core of the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center funded by the National Institutes of Health (NIH AI-51519).

Dr. Shuter has received grant support from the American Legacy Foundation and the Abbott Laboratories Investigator Initiated Research Program.

All other authors have no conflicts of interest to disclose.

This trial is registered with clinicaltrials.gov, trial number NCT01106638.

Received April 4, 2012

Accepted June 12, 2012

© 2012 by Lippincott Williams & Wilkins