Peer Support Boosts Smoking Cessation in HIV

At the recent AIDS 2024 meeting, the 25th International AIDS Conference, Patricia Cioe, PhD, a nurse practitioner in behavioral research at Brown University School of Public Health and an associate professor of behavioral and social sciences in its Center for Alcohol and Addiction Studies, presented findings from an investigation into peer support for people living with HIV who smoke. An HIV care provider since 2001, she provides direct patient care to persons living with HIV.

In the abstract, “Peer navigator support increases positive social support and smoking abstinence in people with HIV who smoke,” findings show that the peer navigators were highly accepted by the patients and there were high rates of engagement, with most patients completing all 12 weekly sessions.

This transcript has been lightly edited.

The American Journal of Managed Care^® (AJMC^®): Can you please discuss your research that is being presented at the conference?

Patricia A. Cioe, PhD | Image Credit: Brown University School of Public Health

Cioe: We presented the findings from a recently completed clinical trial. In this trial, we examined the feasibility, acceptability, and preliminary efficacy of cross-training HIV peer navigators to provide social support for quitting in people with HIV who smoke cigarettes. We're pretty excited about these findings, and we were thrilled that we could present them at the conference.

AJMC: What were your principal findings and did any of the results surprise you?

Cioe: We had several promising initial findings. We found that peer navigators were highly accepted by people with HIV who smoke for this type of program. This didn't surprise us. We were hoping to find this, because peer navigators have been used in HIV clinics for many, many years in the US. And I know they're used in a lot of other countries worldwide as well, to increase engagement in care and medication adherence. Our plan was to cross-train them to help them provide another service, and we really felt at the outset that they would be successful doing this because patients are can relate so closely to peer navigators.

We found that the approach was very feasible. We had excellent rates of engagement with the peer navigator. The peer navigator was introduced at the initial session of the study, and then would follow up with the patient weekly for 12 weeks. The mean number of treatment sessions engaged in by the participants who were in this condition was 8.9, and I know a significant number completed all weekly sessions with the peer navigator—so it was very, very highly accepted.

We also found that participants reported increased social support for quitting at week 12. At the end of the peer navigator intervention, they reported that they had higher levels of social support for quitting. We measured this at baseline, and then at week 12 in both conditions. We did not find this effect in the control condition. So that was very promising, and it meant that peer navigators were doing what they were meant to do—so we were excited by that as well.

We also found that participants who were assigned to the peer navigator condition were twice as likely to report what we call 7-day point prevalence of abstinence, which is a measure we use in smoking cessation trials. That means that over the 7 days prior to that study session, participants report that they did not smoke any cigarettes. So, in our study, they were twice as likely to report that if they had been working with the peer navigator—and that's very exciting.

So we found a lot of good acceptability, a lot of feasibility, good preliminary efficacy, and we also found that the peer navigator required some training. But we expected that and it was not more than we had expected. There was some initial training, and then weekly team meetings where patient cases were discussed, and that was all very doable. So that is something that could translate easily to clinical care.

AJMC: Will your program expand, or was it a 1-time intervention?

Cioe: This was grant funded by the National Institutes of Health, so this study has been completed. But we're hoping to conduct a larger-scale clinical trial. We're hoping to engage at least 2 or more clinics in the next large randomized trial, and we also hope to look at not just the effectiveness of the intervention, but we want to also look at what we call dissemination and implementation outcomes. So we want to look at whether or not this is acceptable by clinical providers, whether or not clinic administration is willing to provide the training, and we're also looking at cost effectiveness. We hope to grow this across the US.

AJMC: Can you tell us the importance of this behavioral change among persons living with HIV at such a granular level, and how that change could reverberate outward and upward?

Cioe: Each patient is so unique. We did a study earlier, which is published, that shows that there are unique barriers to smoking cessation among people living with HIV. So what we have done is designed interventions to address each of these unique barriers that patients report. And one of those barriers was for social support. Patients reported that they don't have good social support for quitting in their networks, that a lot of people around them—family and friends—also smoke, so when they make a quit attempt, it's very much sabotaged by people around them who are continuing to smoke. That is a very significant challenge to abstinence, especially in the first couple of weeks of the process of smoking cessation.

We designed this peer navigator intervention to provide social support for quitting, and it really has great promise because so many clinics in the United States that receive Ryan White funding employ peer navigators. So this we feel should be relatively easy to implement as a large-scale program. We're hoping that it will reverberate outward to many more clinics across the US and could even be implemented worldwide.

AJMC: In what significant ways does smoking affects clinical outcomes in persons with HIV?

Cioe: Smoking cessation among people with HIV is a really significant priority when we're addressing the care and treatment of people living with HIV. People who smoke when they are living with HIV lose more years to smoking than to HIV infection itself; it really is very significant. People with HIV who smoke are twice as likely to have a cardiac event, like a heart attack, and they are 5 times more likely to have smoking-related cancers than people that don't smoke. So it really has significant health concerns, and it really is a public health priority. among this population. It's really very, very important.

The reasons why are multifactorial; it really has a lot to do with everything. It has a lot to do with some persistent viremia that even when they're on antiretroviral therapy, they have chronic inflammation. They have the effects of the nicotine and tobacco, the carcinogenic properties of tobacco, which has a multitude of effects. It's definitely multifactorial.

Reference

Cioe PA, Pinkston M, Stang GS, Tashima K, Kahler CW. Peer navigator support increases positive social support and smoking abstinence in people with HIV who smoke. Presented at: AIDS 2024, July 22-26, 2024; Munich, Germany. Poster EPLB01. https://aids2024.iasociety.org/cmVirtualPortal/_iasociety/aids2024/eposters#/PosterDetail/218