Interventions to help people living with HIV and AIDS to stop using tobacco

Background: Tobacco use is common amongst people living with HIV and AIDS (PLWHA); it causes a range of health problems and accounts for many deaths. There is good evidence about interventions to help people quit tobacco use in the general population, however the effectiveness in PLWHA was not known.

Methods: We reviewed the available evidence from trials to help PLWHA stop using tobacco. This evidence is correct up to June 2015. We conducted analyses of whether people were able to successfully quit tobacco use in the long-term (six months and over) and short-term (measured at less than six months).

Results: We found 14 relevant studies including over 2000 participants. All studies, except one, were conducted in the United States (US). All studies compared a behavioural intervention with medication, to a control group. The behavioural intervention was delivered via a range of methods including face-to-face, telephones, computers, and text messages. Nicotine replacement therapy or varenicline (medications that help tobacco users quit) was also given. Control participants typically received a less intensive, brief behavioural intervention, and the same medication as the intervention group. Six studies of moderate quality evidence investigated long-term abstinence; they did not show clear evidence of benefit of the more intense intervention. Eleven studies of very low quality evidence investigated short-term abstinence. The evidence suggested that a more intense intervention combining behavioural support and medication might help people to quit in the short-term.

Quality of the evidence: The quality of the evidence was judged to be moderate for the long-term abstinence outcome and very low for the short-term abstinence outcome, and so further research is needed to increase our confidence in our findings.

Authors' conclusions: 

There is moderate quality evidence that combined tobacco cessation interventions provide similar outcomes to controls in PLWHA in the long-term. There is very low quality evidence that combined tobacco cessation interventions were effective in helping PLWHA achieve short-term abstinence. Despite this, tobacco cessation interventions should be offered to PLWHA, since even non-sustained periods of abstinence have proven benefits. Further large, well designed studies of cessation interventions for PLWHA are needed.

Read the full abstract...
Background: 

Tobacco use is highly prevalent amongst people living with HIV/AIDS (PLWHA) and has a substantial impact on morbidity and mortality.

Objectives: 

To assess the effectiveness of interventions to motivate and assist tobacco use cessation for people living with HIV/AIDS (PLWHA), and to evaluate the risks of any harms associated with those interventions.

Search strategy: 

We searched the Cochrane Tobacco Addiction Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO in June 2015. We also searched EThOS, ProQuest, four clinical trial registries, reference lists of articles, and searched for conference abstracts using Web of Science and handsearched speciality conference databases.

Selection criteria: 

Controlled trials of behavioural or pharmacological interventions for tobacco cessation for PLWHA.

Data collection and analysis: 

Two review authors independently extracted all data using a standardised electronic data collection form. They extracted data on the nature of the intervention, participants, and proportion achieving abstinence and they contacted study authors to obtain missing information. We collected data on long-term (greater than or equal to six months) and short-term (less than six months) outcomes. Where appropriate, we performed meta-analysis and estimated the pooled effects using the Mantel-Haenszel fixed-effect method. Two authors independently assessed and reported the risk of bias according to prespecified criteria.

Main results: 

We identified 14 studies relevant to this review, of which we included 12 in a meta-analysis (n = 2087). All studies provided an intervention combining behavioural support and pharmacotherapy, and in most studies this was compared to a less intensive control, typically comprising a brief behavioural intervention plus pharmacotherapy.

There was moderate quality evidence from six studies for the long-term abstinence outcome, which showed no evidence of effect for more intense cessation interventions: (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.72 to 1.39) with no evidence of heterogeneity (I2 = 0%). The pooled long-term abstinence was 8% in both intervention and control conditions. There was very low quality evidence from 11 studies that more intense tobacco cessation interventions were effective in achieving short-term abstinence (RR 1.51, 95% CI 1.15 to 2.00); there was moderate heterogeneity (I2 = 42%). Abstinence in the control group at short-term follow-up was 8% (n = 67/848) and in the intervention group was 13% (n = 118/937). The effect of tailoring the intervention for PLWHA was unclear. We further investigated the effect of intensity of behavioural intervention via number of sessions and total duration of contact. We failed to detect evidence of a difference in effect according to either measure of intensity, although there were few studies in each subgroup. It was not possible to perform the planned analysis of adverse events or HIV outcomes since these were not reported in more than one study.

Share/Save