Giuseppe Vittorio De Socio1, Elena Ricci2, Paolo Maggi3, Giancarlo Orofino4, Nicola Squillace5, Barbara Menzaghi6, Giordano Madeddu7, Antonio Di Biagio8, Daniela Francisci1, Paolo Bonfanti9, Francesca Vichi10, Marco dell'Omo11. 1. Unit of Infectious Diseases, Department of Medicine 2, Azienda Ospedaliera di Perugia and University of Perugia, Santa Maria Hospital, Perugia. 2. Department of Woman, Newborn and Child, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 3. Infectious Diseases Clinic, University of Campania "Luigi Vanvitelli," Naples, Italy. 4. Division I of Infectious and Tropical Diseases, ASL Città di Torino, Turin, Italy. 5. Infectious Diseases Unit ASST-MONZA, San Gerardo Hospital-University of Milano-Bicocca, Monza, Italy. 6. Unit of Infectious Diseases, ASST della Valle Olona, Busto Arsizio, Italy. 7. Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy. 8. Department of Health Science (DISSAL), Infectious Disease Clinic, University of Genova, Genova, Italy. 9. Unit of Infectious Diseases, A. Manzoni Hospital, ASST di Lecco, Lecco, Italy. 10. Infectious Diseases Unit, Santa Maria Annunziata Hospital, USL Centro, Florence, Italy; and. 11. Department of Medicine, Perugia University, Perugia, Italy.
Abstract
OBJECTIVE: Assessment of the feasibility and effectiveness of a brief intervention for smoking cessation in people living with HIV (PLWH). SETTING: Multicenter cohort prospective study involving PLWH from 10 Italian infectious disease centers. METHODS: During routine HIV care, clinicians delivered the 5As brief intervention (Ask, Advise, Assess, Assist, Arrange) to each patient who enrolled in the study, following the European AIDS Clinical Society guidelines. At study end, participating clinicians evaluated their own adherence to intervention: "standard" if counseling was delivered in at least half of the follow-up visits, "soft" if less. The main outcome measure was smoking abstinence ≥6 months. Abstinence predictors were evaluated using a Cox-proportional hazard regression model. RESULTS: One thousand eighty-seven PLWH-patients (age 47.9 ± 10.8, male 73.5%) were followed for a median of 23 months (interquartile range 21-25). At baseline, current smokers were 561 (51.6%). Standard intervention was performed in 4 of 10 centers and included 343 smokers; soft intervention was performed in 6 centers (218 smokers). At last visit, 35 patients in standard (10.8%) and 6 in soft intervention (2.8%) achieved self-reported tobacco abstinence ≥6 months (P = 0.0009). Overall, the 5As intervention led to 7.3% 6-month interruptions. In the multivariable analysis, significant predictors for 6-month smoking cessation were: lower Fagerström score, stage of change (preparation/contemplation vs. precontemplation), and standard intervention. CONCLUSION: Adherence to the 5As brief intervention emerged as a critical factor for success. In fact, compared with soft intervention, the standard intervention significantly increased abstinence, highlighting that clinicians need more time and supporting tools to encourage PLWH to quit smoking.
OBJECTIVE: Assessment of the feasibility and effectiveness of a brief intervention for smoking cessation in people living with HIV (PLWH). SETTING: Multicenter cohort prospective study involving PLWH from 10 Italian infectious disease centers. METHODS: During routine HIV care, clinicians delivered the 5As brief intervention (Ask, Advise, Assess, Assist, Arrange) to each patient who enrolled in the study, following the European AIDS Clinical Society guidelines. At study end, participating clinicians evaluated their own adherence to intervention: "standard" if counseling was delivered in at least half of the follow-up visits, "soft" if less. The main outcome measure was smoking abstinence ≥6 months. Abstinence predictors were evaluated using a Cox-proportional hazard regression model. RESULTS: One thousand eighty-seven PLWH-patients (age 47.9 ± 10.8, male 73.5%) were followed for a median of 23 months (interquartile range 21-25). At baseline, current smokers were 561 (51.6%). Standard intervention was performed in 4 of 10 centers and included 343 smokers; soft intervention was performed in 6 centers (218 smokers). At last visit, 35 patients in standard (10.8%) and 6 in soft intervention (2.8%) achieved self-reported tobacco abstinence ≥6 months (P = 0.0009). Overall, the 5As intervention led to 7.3% 6-month interruptions. In the multivariable analysis, significant predictors for 6-month smoking cessation were: lower Fagerström score, stage of change (preparation/contemplation vs. precontemplation), and standard intervention. CONCLUSION: Adherence to the 5As brief intervention emerged as a critical factor for success. In fact, compared with soft intervention, the standard intervention significantly increased abstinence, highlighting that clinicians need more time and supporting tools to encourage PLWH to quit smoking.
Authors: Giuseppe Vittorio De Socio; Marta Pasqualini; Elena Ricci; Paolo Maggi; Giancarlo Orofino; Nicola Squillace; Barbara Menzaghi; Giordano Madeddu; Lucia Taramasso; Daniela Francisci; Paolo Bonfanti; Francesca Vichi; Marco dell'Omo; Luca Pieroni Journal: BMC Public Health Date: 2020-05-20 Impact factor: 3.295