Mobile phone support helps patients with HIV stop smoking

A mobile phone counselling service can help people with HIV to stop smoking – at least in the short-term, US investigators report in the online edition of Nicotine & Tobacco Research.

Patients who used the counselling service were four-times more likely to report abstinence from cigarettes for seven days than individuals who received standard smoking cessation support.

The mobile phone counselling also significantly increased the chances of patients reporting total abstinence from cigarettes, but quitting rates were low.

Patients with HIV are between two and three times more likely to smoke than individuals in the general population. Smoking-related diseases are a major cause of illness and death in HIV-infected patients. Indeed, it has been estimated that stopping smoking could reduce overall mortality in patients with HIV by 16%, the risk of major cardiovascular disease by 20%, and the risk of non-AIDS-defining cancers by 34%.

Surprisingly little research had been conducted among HIV-positive smokers into the efficacy of smoking cessation interventions. However, the limited data which are available are encouraging, and indicate that such services are welcome. Moreover, outcomes of a small pilot study conducted in Houston, Texas, showed that a mobile phone counselling service helped patients to stop smoking.

The investigators who conducted this pilot wanted to assess the effectiveness of telephone counselling in a larger and longer study.

They therefore designed a randomised prospective study lasting three months. It included 474 HIV-positive smokers who wanted to quit. The patients were recruited from the Thomas Street Health Center in Houston, a clinic which provides HIV care to a largely disadvantaged urban population.  

All the patients received brief advice about how to stop smoking, written information, and nicotine replacement therapy.

They were then randomised into two groups.

One group of patients received no further support and were the control arm.

The other patients were given a mobile phone and a prepaid telephone number which enabled them to access counselling support. Patients were provided with eleven counselling sessions over a three-month period. This counselling was based on a cognitive-behavioural therapy model. Patients were also given a “hot-line” number to enable them to access support between these sessions.

The main outcome of the study was seven-day cigarette abstinence after three months. Information was also gathered on long-term abstinence, and 24-hour abstinence was bio-medically assessed by measuring CO₂ levels.

Most the patients were men (70%) and approximately three-quarters were African-American. Their average age was 44 years and they were generally socially disadvantaged, only 24% having a higher education.

At the end of the study, individuals in the mobile phone support group were over four-times more likely to report a seven-day period of cigarette abstinence than patients in the control arm (OR = 4.33; 95% CI, 1.92-9.82).

Mobile phone counselling also increased the chances of 24-hour abstinence (p < 0.001), 30-day abstinence (p = 0.005), and continuous abstinence (p = 0.005).

For patients in the control arm, the mean duration of total cigarette abstinence was six days, significantly shorter than the fifteen-day period reported by individuals who were counselled via the mobile phone service (p < 0.001).

The proportion of patients who managed to completely stop smoking was low (control arm, 2% vs. intervention arm, 9%). The investigators attribute this to changes in prescribing practices for nicotine replacement therapy that required patients to make multiple trips to the clinic.

“By conducting counselling over the cell phone, we were able to greatly increase our ability to consistently contact patients and deliver a relatively intensive intervention,” write the investigators. 

The study is set to continue and it is planned to report and six- and twelve-month outcomes.

“These future analyses will also more fully explore the relationship between treatment group, smoking outcomes, and the various medical and psychiatric comorbidities frequently observed among PLWHA [people living with HIV and AIDS],” comment the authors, “in addition, the effects of motivation, self-efficacy, stress and other psychosocial variables will be explored.”