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Reducing Disparities by Integrating Tobacco Cessation into HIV Care

Institution: University of California, San Diego
Investigator(s): Kimberly Brouwer,
Award Cycle: 2019 (Cycle 29) Grant #: T29IP0584 Award: $497,790
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: High Impact Pilot Award

Initial Award Abstract
Smoking is more than twice as common among people living with HIV (PLWH) compared to the national average, and HIV and tobacco interact to worsen the health effects and mortality rate from heart and lung disease. As poorer and more socially marginalized populations are over-represented among PLWH (e.g. racial/ethnic or sexual minorities, those addicted to drugs), targeting PLWH to quit smoking may be an efficient and effective way to reduce tobacco-related health inequalities. The main goal of this two-year high impact pilot project is to investigate and inform including smoking cessation interventions within the HIV clinical care setting. Specifically, we will: 1) determine the ways PLWH use tobacco and what helps them quit; 2) explore physician and health system practices and opinions regarding including tobacco cessation into the clinical care setting; 3) map smoking cessation interventions that address the competing priorities and challenges of affected communities. To better understand smoking practices and what impedes or helps this population to quit smoking (Aim 1), we will conduct surveys among 500 PLWH and focus groups with PLWH who: i) decided not to try to quit after their doctor suggested they should, ii) unsuccessfully tried to quit, and iii) successfully quit. To meet aim 2, we will give a brief survey to 50 HIV care providers and conduct face-to-face, in-depth interviews with at least 15 HIV service providers to better understand current practices and barriers to combining tobacco cessation with HIV care. To meet aim 3, what we learned from Aims 1 and 2 will inform the selection of possible interventions found useful in other settings, and input from patients, providers, and the community will inform intervention design. Our diverse team, with expertise in treating patients with HIV, developing tobacco cessation interventions, behavioral science, and HIV and substance use epidemiology, is uniquely positioned to conduct this study, which will fill a critical knowledge gap and lay the foundation for interventions to reduce tobacco-related health disparities. The team's strong community ties will also be leveraged to ensure community input and sharing and extension of study results beyond the clinical setting.