Internet-Based Smoke-Ending Program Works in People With HIV

No smoking

Positively Smoke Free on the Web, an internet-based interactive smoking-cessation program designed for people with HIV, led to a twice greater quitting rate than standard care in a randomized trial in the Bronx, New York.

Smoking remains highly prevalent in HIV-positive people and contributes to high rates of cardiovascular disease, cancer, and other illnesses. Programs to help HIV-positive people stop smoking have had mixed results.

This randomized trial at Montefiore Medical Center in the Bronx randomized 138 HIV-positive smokers to Positively Smoke Free on the Web (linked below) or to standard care. Study participants had to be current smokers with an interest in quitting and with access to an internet-linked computer.

Standard care consisted of brief advice, a brochure, and an offer of a 3-month supply of nicotine patches. All study participants had health insurance to cover the cost of patches. The internet-based intervention was an online program with eight sessions, each including 4 to 7 Web pages with interactive features. Participants in this study arm got up to 4 email or text reminders when a new session became available. If they did not log into a new session, they got a reminder call. They also received an offer of a 3-month supply of nicotine patches.

The study group included 76 men, 60 women, and 2 transgendered people. Age averaged about 46, and about three quarters of study participants were black. Ethnically, almost half were Hispanic. While 90% of study participants had stable housing, 86% were unemployed or disabled. CD4 counts averaged 590 cells/µL, and two thirds of study participants had an undetectable viral load.

The Positively Smoke Free group accessed an average 5.5 of 8 online sessions and 26.2 of 41 pages (64%). They spent an average 59.8 minutes logged in. Almost everyone needed a reminder call to log in; only 3 people logged into all 8 sessions with no reminder calls. Factors linked to greater online access were at least a high school education, higher anxiety score, lower stress score, home internet access, and not being infected with HIV during sex between men.

Three months after the last online session was supposed to be completed, 10.1% in the online group and 4.3% in the standard-care group quit smoking. Quitting rates were higher in women than men (11.7% versus 2.7%, P = 0.08) and in people who viewed all 8 online sessions (17.9%), people who viewed all 41 Web pages (17.9%), women who viewed all 8 online sessions (30.8%), and women who viewed all 41 pages (40%).

The researchers believe their findings "suggest that Web-based tobacco treatment, especially if supported by an effective adherence protocol, is a feasible strategy for [HIV-positive] smokers, and preliminary abstinence data suggest that such treatment may increase quit rates."

Source: Jonathan Shuter, Daniela A. Morales, Shannon E. Considine-Dunn, Lawrence C. An, Cassandra A. Stanton. Feasibility and preliminary efficacy of a web-based smoking cessation intervention for HIV-infected smokers: a randomized controlled trial. JAIDS. 2014; 67: 59-66.

Written by Mark Mascolini on behalf of the International AIDS Society