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Randomized Controlled Trial
. 2018 Oct 1;79(2):261-268.
doi: 10.1097/QAI.0000000000001787.

Integrated Treatment for Smoking Cessation, Anxiety, and Depressed Mood in People Living With HIV: A Randomized Controlled Trial

Conall OʼCleirigh  1   2 , Michael J Zvolensky  3   4 , Jasper A J Smits  5 , Allison K Labbe  1   2 , Jessica N Coleman  1   6 , Julianne G Wilner  1   7 , Amelia M Stanton  5 , Adam Gonzalez  8 , Lorra Garey  3 , Kristen S Regenauer  1 , David Rosenfield  9
Affiliations
Randomized Controlled Trial

Integrated Treatment for Smoking Cessation, Anxiety, and Depressed Mood in People Living With HIV: A Randomized Controlled Trial

Conall OʼCleirigh et al. J Acquir Immune Defic Syndr. .

Abstract

Objective: Among people living with HIV, cigarette smoking rates are higher than among the general population, and anxiety, depression, and their disorders are common and associated with smoking and poorer outcomes during cessation. This study evaluated the efficacy of an integrated smoking cessation intervention, developed to target anxiety, depression, and smoking cessation concurrently among people living with HIV.

Method: Smokers living with HIV who reported at least moderate motivation to quit smoking were randomized into a novel 9-week integrated intervention (QUIT), consisting of 1 psychoeducation (prerandomization) session and 9 weekly 1-hour sessions of cognitive behavioral therapy for smoking cessation and anxiety/depression plus nicotine replacement therapy, or a 9-week enhanced standard smoking intervention (ETAU), consisting of 1 psychoeducation session (prerandomization) and 4 brief weekly check-in sessions plus nicotine replacement therapy. All were instructed to make a quit attempt at week 6.

Results: Seventy-two participants were enrolled, and 53 were randomized. 41/53 participants completed the active treatment phase of the study. 7-day point-prevalence abstinence, verified with expired carbon monoxide, was significantly higher among those in the integrated intervention than those in the enhanced standard intervention both end-of-treatment {[MQUIT = 59%, METAU = 9%; b = 5.60, 95% confidence interval: (2.64 to 8.56), t(332) = 3.72, P < 0.001]} and 6-months post-quit date {[MQUIT = 46%, METAU = 5%; b = 7.69, 95% confidence interval: (4.60 to 10.78), t(332) = 4.90, P < 0.001]}. Consideration of patterns of missingness did not alter the significance of these findings.

Conclusions: The integrated intervention was associated with substantially higher short-term and long-term abstinence rates than the enhanced standard intervention. These data provide promising initial evidence supporting the benefits of an integrated anxiety-depression/smoking cessation program specifically tailored for people living with HIV.

Trial registration: ClinicalTrials.gov NCT01393301.

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Conflict of interest statement

J.A.J.S. has received compensation from Microtransponder, Inc., and Aptinyx, Inc. for consulting. The remaining authors have no conflicts of interests to disclose.

Figures

FIGURE 1.
FIGURE 1.
CONSORT diagram. a Completion is defined as completing at least 7/10 sessions; b One participant who did not complete treatment returned for this visit; c One participant who did not complete 2-month follow-up returned for this visit; d Two participants who did not complete 4-month follow-up returned for this visit; e One participant who did not complete 4-month follow-up returned for this visit.
FIGURE 2.
FIGURE 2.
Point prevalence abstinence at major endpoints. *Indicates that abstinence rates are significantly higher in QUIT than in ETAU at the tested endpoints of POST and/or 6-month follow-up. A, Missing data treated as missing. B, Missing data imputed using last observation carried forward.
FIGURE 3.
FIGURE 3.
Multivariate anxiety and depression symptoms (z-scored STAI-S, SIGH-A, CES-D, and MADRS) at major assessments. *Indicates that abstinence rates are significantly higher in QUIT than in ETAU at the tested endpoints of EOT and/or 6-month follow-up.
See this image and copyright information in PMC

References

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