Computer MI for Tobacco Quitline Engagement in Smokers Living With HIV

Cigarette smoking is now a leading cause of morbidity and mortality among people living with
HIV (PLWH) engaged in highly active antiretroviral therapy (HAART) [2-5]. Between 40-70% of
PLWH in the U.S. currently smoke [6-14], in comparison to 20.6% of the general population
[15], and tobacco accounted for nearly 25% of all deaths in a multinational cohort of PLWH
who used HAART [2]. PLWH who smoke are uniquely vulnerable, moreso than smokers without HIV,
to developing cardiovascular [2, 16] and lung [2, 17] diseases, and also are at greater risk
than non-smoking PLWH for a multitude of HIV-associated illnesses [3, 5, 18, 19]. Against
this backdrop, HIV treatment providers acknowledge the importance of assisting PLWH with
smoking cessation, but a significant proportion of them lack confidence, training, and/or
time [10, 12, 20]. Very little research on smoking cessation interventions for PLWH has been
published, and none has evaluated approaches that could be easily disseminated and
integrated into standard HIV care. In this context, a sophisticated, efficacious [ORs,
1.4-1.6 in meta-analyses [21, 22]] tobacco quitline network is now available in every U.S.
state via a national quitline portal, 1-800-QUIT-NOW and represents an untapped resource for
PLWH. Notably, the most positive findings, to date, for smoking cessation in PLWH have
involved telephone counseling delivered by clinical research staff [1], but no existing
studies have reported on the efficacy of engaging PLWH with tobacco quitlines or on brief
motivational approaches to facilitate this process.

The long-term goal of this research program is to disseminate an effective, brief
computer-based intervention that can be readily integrated into community-based, HIV
treatment settings to motivate tobacco quitline use among smokers living with HIV. The
overall objective of this application, which is the first step in the attainment of our
long-term goal, is to develop this computer-based intervention, modify it based on initial
piloting and feedback to insure its feasibility and acceptability, and obtain preliminary
data supporting the efficacy of the intervention. The rationale for the proposed research is
that many smokers living with HIV are interested in quitting smoking, and that by exploring
their smoking-related concerns, providing feedback and enhancing self-efficacy, they can
become motivated to engage in smoking cessation counseling, utilizing a no-cost, readily
available treatment option-their local tobacco quitline. We plan to accomplish the objective
of this application by pursuing the following three specific aims:

1. To develop a brief, computer-based intervention, the CI-METQ - Computer Intervention to
Motivate Engagement in Tobacco Quitline treatment in PLWH who smoke. Also, to develop a
computer-based, time matched nutrition education for PLWH control intervention (NC).

1a. Following the development of the prototype, we will conduct a preliminary pilot test of
the CI-METQ with 8 smokers living with HIV, followed by in-depth interviews with each
individual to develop an understanding of the strengths and limitations of the intervention.
We will then utilize the interview feedback to guide the modification and refinement of the
CI-METQ, after which we will repeat the process with another 8 smokers living with HIV.

1b. The data collected from these 16 interviews regarding feasibility, acceptability and
barriers that would limit effectiveness will guide the investigators in making the
appropriate modifications to finalize the CI-METQ prior to preliminary testing in a small,
randomized controlled trial (RCT).

1c. A similar iterative process will occur with 4 PLWH who smoke in developing the NC
condition.

2. To conduct a preliminary RCT with 100 smokers living with HIV, comparing CI-METQ to a
computer-based, time matched nutrition control (NC) equated for the offer of a tobacco
quitline referral and if engaged with quitline, 8 weeks of nicotine patch at no cost. We
expect: 2a. CI-METQ relative to NC will result in increased readiness for smoking cessation
post-intervention and higher rates of engagement in smoking cessation treatment.

2b. CI-METQ relative to NC will result in a greater proportion of participants making at
least one 24 hour quit attempt over the six months post-intervention and in higher rates of
7-day point prevalence abstinence at 1-, 3- and 6- month follow-ups.

2c. To examine the effect of CI-METQ vs. NC on health-related quality of life over 6-month
follow-up.

3. To explore potential mechanisms that may underlie the efficacy of CI-METQ: 3a. We will
examine CI-METQ's effects on key mechanisms self-reported during the computer session:
concerns about cigarette smoking, likelihood of reducing or quitting smoking, health
benefits of quitting, and satisfaction with the brief intervention content.

3b. We will examine the associations of these dynamic changes with smoking cessation
treatment engagement and smoking outcomes at 1-, 3- and 6-month follow-ups.

With regard to expected outcomes, the work proposed in aims 1 - 3 is expected to result in
the development of a brief, computer-based intervention that will produce preliminary data
showing increased tobacco quitline utilization and smoking cessation in smokers living with
HIV. Such results are expected to have an important positive impact, moving us closer to the
long-term goal of dissemination and integration of a cost-effective, CI-METQ into
community-based, HIV treatment settings, to motivate tobacco quitline use in PLWH who smoke.

Inclusion Criteria:

- 18 - 70 years of age

- current smoker (i.e., at least 10 cigarettes/day)

- HIV seropositive

- English speaking

- reliable access to a telephone (own cellular phone or a landline in their home)

- agreed to be available over the next 6 months.

Exclusion Criteria:

- cognitive impairment sufficient to impair provision of informed consent or study
participation

- current use of nicotine replacement therapy (NRT) or other pharmacotherapy for
smoking cessation

- use of other tobacco products