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Meta-Analysis
. 2016 Jun 13;2016(6):CD011120.
doi: 10.1002/14651858.CD011120.pub2.

Interventions for tobacco use cessation in people living with HIV and AIDS

Erica R M Pool  1 , Omara Dogar, Ryan P Lindsay, Peter Weatherburn, Kamran Siddiqi
Affiliations
Meta-Analysis

Interventions for tobacco use cessation in people living with HIV and AIDS

Erica R M Pool et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality.

Objectives: To assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions.

Search methods: We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases.

Selection criteria: Controlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA.

Data collection and analysis: Two review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria.

Main results: We identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I(2) = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I(2) = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study.

Authors' conclusions: There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.

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Conflict of interest statement

Erica Pool (EP), Omara Dogar (OD), Ryan Lindsay (RL), and Peter Weatherburn (PW) have no conflicts of interest to declare. Kamran Siddiqi (KS) has received a research grant (GRAND 2014) from Pfizer, a pharmaceutical company that makes drugs for tobacco cessation.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Tobacco cessation intervention versus control, outcome: 1.1 Proportion of participants abstinent.
5
5
6
6
Funnel plot of comparison: 2 Tobacco cessation intervention versus control, outcome: 2.1 Short‐term abstinence (4 weeks to < 6 months).
1.1
1.1. Analysis
Comparison 1 Tobacco cessation intervention versus control, Outcome 1 Long‐term abstinence (≥ 6 months).
2.1
2.1. Analysis
Comparison 2 Tobacco cessation intervention versus control, Outcome 1 Short‐term abstinence (4 weeks to < 6 months).
3.1
3.1. Analysis
Comparison 3 Subgroup by drug, Outcome 1 Cessation at long‐term follow‐up.
3.2
3.2. Analysis
Comparison 3 Subgroup by drug, Outcome 2 Cessation at short‐term follow‐up.
4.1
4.1. Analysis
Comparison 4 Subgroup by control, Outcome 1 Long‐term cessation.
4.2
4.2. Analysis
Comparison 4 Subgroup by control, Outcome 2 Short‐term cessation.
5.1
5.1. Analysis
Comparison 5 Subgroup by provider, Outcome 1 Cessation at long‐term follow‐up.
5.2
5.2. Analysis
Comparison 5 Subgroup by provider, Outcome 2 Cessation at short‐term follow‐up.
6.1
6.1. Analysis
Comparison 6 Subgroup by mode of contact, Outcome 1 Cessation at long‐term follow‐up.
6.2
6.2. Analysis
Comparison 6 Subgroup by mode of contact, Outcome 2 Cessation at short‐term follow‐up.
7.1
7.1. Analysis
Comparison 7 Subgroup by selection, Outcome 1 Cessation at long‐term follow‐up.
7.2
7.2. Analysis
Comparison 7 Subgroup by selection, Outcome 2 Cessation at short‐term follow‐up.
8.1
8.1. Analysis
Comparison 8 Subgroup by tailoring, Outcome 1 Cessation at long‐term follow‐up.
8.2
8.2. Analysis
Comparison 8 Subgroup by tailoring, Outcome 2 Cessation at short‐term follow‐up.
9.1
9.1. Analysis
Comparison 9 Subgroup by number of sessions, Outcome 1 Cessation at long‐term follow‐up.
10.1
10.1. Analysis
Comparison 10 Subgroup by total contact time, Outcome 1 Cessation at long‐term follow‐up.
See this image and copyright information in PMC

References

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Berg 2014 {published data only}
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NCT01393301 {published data only (unpublished sought but not used)}
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NCT01436136 {published data only}
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NCT02029612 {published data only}
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Pedrol‐Clotet 2006 {published data only}
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Shelley 2014 {published data only}
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References to ongoing studies

NCT00701896 {published data only}
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NCT01363245 {published data only}
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NCT01484340 {published data only}
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NCT01710137 {published data only}
    1. NCT01710137. Varenicline for nicotene dependence among those living with HIV/AIDS. clinicaltrials.gov/ct2/show/NCT01710137 2012.
NCT01800019 {published data only}
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NCT01886924 {published data only}
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NCT01965405 {published data only}
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NCT02072772 {published data only}
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References to other published versions of this review

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