Effectiveness of an Integrated Treatment to Address Smoking Cessation and Anxiety/Depression in People Living with HIV

Early data indicate that smoking increases the severity of coronavirus disease (COVID-19) symptoms.Individuals living with HIV are more likely to smoke and less likely to quit than those in the general population,placing them at high risk for poor COVID-19 outcomes. Comorbidities associated with HIV, includingcardiovascular disease and chronic lung disease, further heighten risk for a severe course of COVID-19 illness,which has been linked to over 40,000 deaths in the U.S. thus far. To mitigate COVID-19 related healthdisparities and inform intervention strategies, it is crucial to assess the degree to which nicotine dependenceand HIV disease stage affect the onset and progression of COVID-19 in smokers living with HIV. Disruptions to engagement in HIV care and antiretroviral therapy regimens may compromise efforts tomaintain viral suppression and lead to increases in rates of anxiety and depression, both of which are alreadyelevated in individuals living with HIV compared to the general population. Increases in negative affect (anxietyand depression) are established pathways to smoking relapse among smokers living with HIV who may usecigarettes to regulate their negative mood; therefore, increases in anxiety and depression resulting from theCOVID-19 pandemic could impact smoking cessation and relapse. Given the primary outcomes of the parentgrant, we will also examine the ways in which COVID-19 related mental health responses COVID-19influenceuptake of smoking cessation treatments, smoking abstinence, and other relevant smoking outcomes. This proposed Administrative Supplement is responsive to the Notice of Special Interest regarding theAvailability of Administrative Supplements Research on the 2019 Novel Coronavirus (NOSI - NOT-DA-20-047)issued by NIDA and is appropriate to PA-18-591 (Administrative Supplements to Existing NIH Grants).Specifically, our application is responsive to 3 areas of research requested by the NOSI: (1) "Research todetermine whether substance use (especially smoking tobacco...) is a risk factor for the onset and progressionof COVID-19," (2) "Research on how HIV among persons who use substances may impact the onset andprogression of COVID-19," and (3) "Research using ongoing studies to understand the broad impacts ofCOVID-19 (e.g., anxiety...) on ..., substance use, substance use disorders, and access to addiction treatment." Through this administrative supplement application we directly address these three areas and propose thefollowing specific aims: (1) to quantify the relationship among baseline nicotine dependence severity, baselineHIV disease stage and their interaction), with COVID-19 outcomes (COVID-19 susceptibility, clinical symptomburden, level of treatment, COVID-19 disease outcome) over up to 2 years of follow up; and (2) quantifymanifestations of negative affect that have emerged in response to the COVID-19 pandemic and the degree towhich these different manifestations impact uptake of smoking cessation treatments over the follow up period.We will achieve these aims by leveraging the of our parent R01 grant.