THE EFFICACY OF TOBACCO CESSATION INTERVENTIONS FOR PERSONS LIVING WITH HIV/AIDS: A SYSTEMATIC REVIEW AND META-ANALYSIS
While the life expectancy of PLWHA continues to improve due to advances in HIV treatment, including highly active antiretroviral therapy (HAART), greater attention is focusing on modifiable risk factors that may further reduce morbidity and mortality in PLWHA. One of the most important of these risk factors is tobacco smoking
Knowing that tobacco use is highly prevalent and responsible for significant morbidity and mortality amongst PLWHA (Helleberg et al., 2013), it is of the utmost importance that evidence based literature be available to support PLWHA, and their healthcare providers. A dedicated review of cessation interventions in PLWHA is justified as the morbidity and mortality of PLWHA somewhat differ from those of other smokers, and despite their motivation to quit, PLWHA often find it challenging to achieve unremitting abstinence from tobacco (Pool, Dogar, Lindsay, Weatherburn, & Siddiqi, 2016).
English language articles from January 200 through February 2018 were searched. The criteria for inclusion were randomized controlled trials that described a smoking-cessation intervention in PLWHA. The search was conducted from January through March of 2018 and spanned literature published since 2000. Intervention that were not experimental or quasi-experimental (QE) or that were delivered to participants who were not PLWHA were excluded. The studies were restricted to PLWHA smokers of any age with self-reported cigarette use. Studies were excluded if they were not randomized control trials. Included studies were ones with 7-day point prevalence abstinence at weeks 12, 24, or 52; with self-reported abstinence in the past 7 days and exhaled carbon monoxide ?10 ppm, and continuous, self reported abstinence since baseline and exhaled carbon monoxide ?10 ppm at all follow-up visits up to and including weeks 12, 24, or 52. There were no sample size limitations.
Using RevMan the odds ratios (OR) ratios and the weighted pooled OR ratios across studies. Seven of the 10 clinical trials reported favorable results on the efficacy of treatment. Three of the 10 clinical trials reviewed did not find treatment efficacy. The meta-analysis of the dichotomous 8 studies that evaluated the efficacy of the enhanced care interventions for smoking cessation resulted in a moder- ate statistically significant effect size for abstinence with an OR of 2.84 (95$ CI 1.93 to 4.17). For the continuous studies only Shuter et al. was found to be effective with an OR of 4.55 (95% CI 0.11 to 9.21). Heterogeneity of the studies was assessed and found to be Chi² = 12.28, df = 6 (P = 0.06); I² = 51%, and Chi² = 3.62, df = 2 (P = 0.16); I² = 45%, respectively
It should be noted even when intervention participants were provided NRT, there was little to no difference in treatment effect. When readiness to quit, or motivation to quit was assessed either at baseline or follow-up, there was a treatment effect, leading to the conclusion that when no treatment effect was found, the participants may have either been in the precontemplation, contemplation stage which may have led to low cessation rates(Keith, Dong, Shuter, & Himelhoch, 2016). Based on the data presented in the included studies, targeted tobacco cessation interventions for PLWHA are effective.