Need With the progress made in HIV treatment over the past 30 years, the lifespan of those infected with HIV has risen to levels comparable to non-infected individuals. This, in turn, has revealed other prevalent causes of morbidity and mortality such as higher rates of lung cancer among HIV positive individuals who use tobacco. Despite falling steadily over the past several decades in the general public, rates of tobacco use among people living with HIV (PLWH) remain high (42%-70%). This is often attributed to a number of factors ranging from the psychological and psychiatric to physical and socioeconomic. Additionally, cessation services tailored to HIV positive patients are not widely off...

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Need With the progress made in HIV treatment over the past 30 years, the lifespan of those infected with HIV has risen to levels comparable to non-infected individuals. This, in turn, has revealed other prevalent causes of morbidity and mortality such as higher rates of lung cancer among HIV positive individuals who use tobacco. Despite falling steadily over the past several decades in the general public, rates of tobacco use among people living with HIV (PLWH) remain high (42%-70%). This is often attributed to a number of factors ranging from the psychological and psychiatric to physical and socioeconomic. Additionally, cessation services tailored to HIV positive patients are not widely offered and there is no standard treatment methodology shown to be most effective in this population. Substantial barriers to accessing appropriate cessation services and adhering to intensive treatment result in low cessation rates, signaling a lack of efficacy in existing cessation programs for this population. Overall Project Strategy Based on our experience working with PLWH in Bexar, Guadalupe, Comal, and Wilson County, we propose an improvement to the approach of lung cancer prevention and tobacco cessation treatment for PLWH with an intensive, tailored behavioral intervention that will be sensitive to the unique needs of each patient and their barriers to treatment. We will provided tobacco cessation services to PLWH by combining the duties and competencies of a Certified Tobacco Treatment Specialist (CTTS) with that of a Patient Navigator (PN) to consolidate services for this population and remove the barriers to connecting patients to treatment. In addition, we will engage patients over an extended treatment period (24 weeks). This prolonged treatment period combined with our enhanced CTTS PN treatment model will enhance cessation rates among PLWH and successfully prevent lung cancer in this vulnerable, underserved and underfunded population. Specific Goals The goals of the proposed program, Navigation to Cessation (N2C), are to 1) increase tobacco prevention awareness, 2) increase tobacco screening, and 3) increase tobacco cessation among PLHW, ages 18 and older, served at five partnering clinic locations in the Bexar County community. We will achieve Goal 1 by launching a tobacco prevention media campaign expected to reach 9,000 patients and community members. Participating clinic providers will reinforce these prevention messages by educating 90% of PLWH, ages 18 and older, on the N2C program and other tobacco prevention and cessation services, including but not limited to pharmacological treatment. To increase screening for tobacco use among 90% of PLWH by the end of the 36 month funding period (Goal2),we will educate 90% of service providers (10 of 11 providers total) at each of the five clinic sites on best practices and tobacco treatment techniques for PLWH. As a result of increased screening we expect an equal increase in referrals to N2C program. Thus by the end of the 36 month funding period, we expect to enroll 800 PLWH, ages 18 and older, in the N2C program and demonstrate a statistically significant increase in tobacco cessation by enrollees at the end of program participation. To achieve Goal 3, we will ensure 80% of program participants receive at least 3 CTTS PN sessions. Significance and Impact As South Texas’ safety net health system, University Health System provides care for 28 counties. In this region, the entirety of the uninsured, underserved population rely on University Health System to provide health care services. N2C fills a gap within the region that will create an opportunity for University Health System to reduce cancer within a high-risk population and assist in overcoming barriers to care experienced by our patient population. University Health System’s N2C program will improve the health of Bexar County’s HIV/AIDS community by providing PLWH a comprehensive, integrated continuum of HIV care that includes an innovative lung cancer prevention tobacco cessation program. Applicable to other HIV/AIDS populations regardless of region or demographic makeup, the N2C will serve as a demonstration to establish a more effective tobacco cessation program that will be disseminable across the nation.. Moreover, seeing how advancement in HIV/AIDS care has moved the disease status to that of a chronic disease, the N2C model will also apply to other populations who are underserved and suffering from non-HIV chronic diseases.

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