Impact of Behavior Modification Interventions and Lung Cancer Screening on Smoking Cessation in People Living With HIV: A Feasibility Study

Inclusion Criteria:

• Able to understand and willing to sign a written informed consent document

• HIV positive. Documentation of HIV-1 infection by means of any one of the following:

• Documentation of HIV diagnosis in the medical record by a licensed health careprovider;

• Documentation of receipt of antiretroviral therapy (ART) (at least twodifferent medications that do not constitute a prescription for pre-exposureprophylaxis [PrEP] or post-exposure prophylaxis [PEP]) by a licensed healthcare provider. Documentation may be a record of an ART prescription in theparticipant's medical record, a written prescription in the name of theparticipant for ART, or pill bottles for ART with a label showing theparticipant's name;

• HIV-1 ribonucleic acid (RNA) detection by a licensed HIV-1 RNA assaydemonstrating > 1000 RNA copies/mL;

• Any licensed HIV screening antibody and/or HIV antibody/antigen combinationassay confirmed by a second licensed HIV assay such as a HIV-1 Western blotconfirmation or HIV rapid multispot antibody differentiation assay.

Note: The term "licensed" refers to a kit that has been certified or licensed by an oversight body within the participating country and validated internally (e.g., U.S. Food and Drug Administration [FDA]).

WHO (World Health Organization) and CDC (Centers for Disease Control and Prevention) guidelines mandate that confirmation of the initial test result must use a test that is different from the one used for the initial assessment. A reactive initial rapid test should be confirmed by either another type of rapid assay or an E/CIA that is based on a different antigen preparation and/or different test principle (e.g., indirect versus competitive), or a Western blot or a plasma HIV-1 RNA viral load

• Receiving antiretroviral therapy and CD4 count at least 200 cells/uL within 6 monthsof registration (due to increased risk of LDCT false positivity with CD4 count < 200cells/uL)

• Age 45-80 years. This age restriction reflects lung cancer risk and appropriatenessfor lung cancer screening; in epidemiologic studies lung cancer emerges 5-10 yearsearlier in PLWH, and therefore this is an appropriate risk group for screening.Although younger persons are likely to benefit more from smoking cessation as a lungcancer prevention measure, the risk/benefit ratio associated with lung cancerscreening is unlikely to be optimal at ages < 45 years for PLWH

• Biochemically confirmed current smoker (exhaled carbon monoxide [CO] >= 7 parts permillion)

• Meets United States Preventive Services Task Force (USPSTF) criteria for LDCT (age 50-80 and >= 20 pack-years smoking) or high-risk but not meeting USPSTF (age 45-49and >= 20 pack-years smoking)

• Possession of a smartphone that can support Positively Smoke Free Mobile (PSF-M) (> 95% of subjects had eligible phones in prior trials although researchers willinclude specific study screening questions assessing for adequate smartphone for theintervention)

• Sufficient literacy; >= 4 on the Rapid Estimate of Adult Literacy in Medicine-ShortForm (REALM-R) literacy scale

Exclusion Criteria:

• Receiving any other smoking cessation interventions currently or within the prior 30days

• Contraindication to nicotine replacement therapy

• Pneumonia or serious lung infection in prior 12 weeks

• Uncontrolled intercurrent illness including, but not limited to, ongoing or activemajor infection, malignant tumors (unless these tumors were: (a) completely resectedbasal cell or squamous cell skin carcinomas or (b) in-situ squamous cell carcinomaof the cervix or anus), or any other major uncontrolled comorbid condition thatwould limit life expectancy or psychiatric illness/social situations that wouldlimit compliance with study requirements

• History of lung cancer

• Pregnant women are excluded from this study because computed tomography introducesradiation exposure and may have teratogenic effects

• Women who are breastfeeding (the safety of nicotine replacement therapy has not beenestablished with breastfeeding)

• Received a chest computed tomography scan in the previous twelve months