JMIR Publications

ABSTRACT

Background:

More people who smoke and are living with HIV now die from tobacco-related disease than HIV. Most are ambivalent about quitting smoking: they want to quit someday, but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking who have HIV (PAQS-HIV).

Objective:

To develop an app-based intervention for PAQS-HIV and assess its feasibility, acceptability, and potential impact. Results will inform plans for future research and development.

Methods:

In Phase 1, PAQS-HIV (n = 8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In Phase 2, PAQS-HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS-HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants’ willingess to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction, utilization) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19).

Results:

Recruitment was a challenge for both study phases, particularly via online and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the Phase 2 randomized study was good; 74% (14/19) completed the 3-month follow-up. Phase 1 findings suggested PAQS-HIV are receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability trended in favor of the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at 3-month follow-up.

Conclusions:

Based on the current formative work, PAQS-HIV individuals may be receptive to using a mHealth-based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate additional research and development are warranted. Clinical Trial: The study is registered with ClinicalTrials.gov (NCT05339659).