A randomized controlled pilot trial of a smoking cessation intervention for US women living with HIV: telephone-based video call vs voice call

  • Sun Kim, Sabreen Darwish, Sang A Lee, Courtenay Sprague, Rosanna F DeMarco
  • International Journal of Women s Health, September 2018, Dove Medical Press
  • DOI: 10.2147/ijwh.s172669

A 'quit smoking' RCT for women living with HIV in the US testing telephone-video call vs voice call

What is it about?

Background: People living with HIV smoke at a rate three times that of the general population. This randomized controlled pilot trial tested the feasibility and acceptability of a video-call smoking cessation intervention in women living with HIV and its preliminary efficacy compared with a voice-call smoking cessation intervention. The study focused on women due to a paucity of studies among this population, and women are less likely than men to quit smoking when provided with conventional treatment. Methods: Participants in both arms received an HIV-tailored smoking cessation intervention comprising eight 30-minute weekly counseling sessions in conjunction with active nicotine patches for 8 weeks. The only difference between the two arms was the delivery mode of the intervention: via either telephone-based video or voice call. Survival analysis and a Cox proportional hazard regression model were performed to identify factors predicting 6-month prolonged abstinence from smoking. Results: A video-call intervention was almost 30% less feasible than a voice-call intervention because women in their 50s and 60s or poorer women living in some southern states did not have access to video-call equipment. However, those who received the video-call intervention were more likely to complete the study than those who had the voice-call intervention. There was no difference in the acceptability of the two interventions. A survival analysis revealed that those in the video arm were significantly more likely to maintain smoking abstinence over the 6-month follow-up period than those in the voice arm (log rank χ2=4.02, P,0.05). Conclusion: Although a video-call intervention is less feasible than a voice-call intervention, the former seems to outperform the latter in achieving long-term smoking abstinence for women living with HIV, which may offer an advantage over establishing therapeutic alliance and visually monitoring their adherence to nicotine patches.

Why is it important?

People living with HIV (PLWH) smoke cigarettes at a rate three times that of the general population: 40%–80% compared to 19% [1,2]. One large cohort study estimated that 24% of deaths in PLWH with antiretroviral therapy (ART) are attributable to tobacco use[3]. Smoking cessation is therefore crucial to reduce the high mortality rate in this population and to improve their quality of life. A systematic review of smoking cessation studies reported that PLWH prefer telephone to in-person counseling[4]. However, the rates of abstinence achieved by PLWH who received telephone counseling were relatively low at 6%–16%, compared to the rates of in-person counseling, ranging from 15% to 30%.[5-7] Gender differences have been established related to smoking cessation. For example, women have significantly lower confidence in quitting smoking and lower success rates than men, especially when treated with nicotine replacement therapy (NRT) alone or in combination with brief counseling [16-22]. A meta-analysis reported that women would require more intensive counseling support for smoking cessation than their male counterparts [23]. Overall, there is a dearth of smoking cessation studies focused on women living with HIV. Compared to men, women living with HIV are more likely to face significant impediments in accessing health care services and treatments that they need to cease smoking, including socioeconomic and structural barriers such as childcare needs and intimate partner violence [24,25], hence the need for targeted research in this area.


Courtenay Sprague
University of Massachusetts Boston

We found that the video-call smoking cessation intervention had greater feasibility in terms of retention than the voice-call one, which suggests that video-call counseling might be better in establishing therapeutic alliance than voice-call counseling. Along with a better retention rate, our study found a large treatment effect of video-call over voice-call counseling. Based on this finding, it would be worthwhile to conduct a large-scale clinical trial to investigate whether the finding would be replicable in larger groups of women living with HIV. If video-call cessation counseling were found to be effective compared with telephone cessation counseling, the intervention modality might pose an ideal alternative to the traditional telephone counseling and could be adopted in a nationwide smoking quit-line service, especially for women living with HIV.

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The following have contributed to this page: Dr. Sun S Kim and Courtenay Sprague