A smoking cessation programme in HIV-infected individuals: a pilot study.

BACKGROUND: Antiretroviral therapy (ART) is a risk factor for cardiovascular disease (CVD) and smoking the most important modifiable cardiovascular risk factor. METHODS: We prospectively evaluated a smoking cessation programme (SCP) in HIV-infected individuals (intervention: counselling and nicotine replacement therapy). Primary endpoint was the smoking cessation rate at 12 months; secondary endpoints were CVD morbidity and mortality. Controls were a not randomized control group of smokers not participating in the SCP. RESULTS: Four-hundred and seventeen of 680 (61%) patients were smokers, and 34 of these participated in the SCP. Of these 34 individuals, 82% were male, the median age was 43 years, prior AIDS was recorded in 29%, and depressive disorder was recorded in 18/%. Twenty-five (74%) patients were receiving ART. Additional risk factors were dyslipidaemia (68%), a prior cardiovascular event (24%), hypertension (1 5%), and a family history of CVD in 2/34 (6%) individuals. According to the Framingham equation, the 10-year risk of CVD was higher in SCP participants than in controls (11.2% versus 8.5%, P=0.06). At termination of the SCP, 17/34 (50%) individuals had stopped smoking compared with 57/383 (15%) controls. Self-reported smoking abstinence for a12 months was 13/34 (38%) in the intervention group and 27/383 (7%) in the control group (odds ration 6.2, 95% confidence interval 2.8-14.3). During the follow-up, two SCP participants and 4 controls experienced a myocardial infarction. One patient in the control group died of CVD. CONCLUSIONS: SCP in HIV-infected individuals is feasible and should be encouraged. The long-term impact of smoking cessation on CVD morbidity and mortality should be evaluated in comparative trials.

[An evidence-based guideline to support HIV/AIDS patients with alcohol problems]. / Beratungsempfehlung für HIV/AIDS-infizierte Menschen, deren Alkoholkonsum ein gesundheitliches Problem darstellt.

It is estimated that 300,000 people with alcohol problems and alcohol-related illnesses are presently living in Switzerland. Many of these are infected with HIV. Yet, the number is unknown. At the HIV outpatient department of the University Hospital in Basel, nurses are assessing patients and it is evident that alcohol intake is a serious health problem for some of them. In order to provide evidenced-based care to these patients, a clinical practice guideline was developed based on a comprehensive literature review and synthesis. The guideline has been implemented and helps nurses and other healthcare providers to effectively assess and provide a short-term intervention to those patients with HIV who have alcohol-related problems. For the assessment, two instruments are utilized: the AUDIT and the CAGE. These instruments were selected after evaluation as being the most sensitive and specific for patients in an ambulatory setting. Patients are also assessed for their readiness to change. In this article, the literature will be reviewed and the guideline introduced, as a basis for nurses and other health care providers to provide evidence-based care for HIV-infected patients who have alcohol-related problems.

The Advanced Nursing Practice Team as a model for HIV/AIDS caregiving in Switzerland.

To offer advanced nursing care for people living with HIV, a participatory action research project was initiated that enabled constant learning and change at the levels of (a) the culture and organization of an outpatient department, (b) clinical leadership and interdisciplinary collaboration, and (c) development of new services. In this project, the development of the Advanced Nursing Practice (ANP) Team not only affected the practice of individual nurses with advanced degrees but also created a team of nurses educated at different levels. Through a systematic process, the nurses on the team became more educated and refined their clinical expertise. An essential aspect of the ANP Team was the specialization of each nurse in a self-selected topic within HIV/AIDS care. As members of the ANP Team, the nurses offer state-of-the-art nursing care including patient assessment, medication management and adherence support, symptom management, health maintenance and prevention, and family support for persons living with HIV.

[Smoking cessation for HIV infected patients]. / Ein Rauchstopp-Programm für HIV-infizierte Menschen.

Cigarette smoking is one of the leading health problems of the general and also of the HIV population. At the HIV clinic at the University Hospital in Basel, Switzerland, many patients expressed the desire to quit smoking. Therefore, an evidence based smoking cessation program was established. The program bases on the two intervention strategies, which have been evaluated as most effective in the state-of-the-art literature: Nicotine substitution and counseling. Counseling bases on dialogues and empowerment. Our smoking cessation program includes a short-term intervention, general information, and a counseling program in several parts. Until recently, in Switzerland, mainly physicians have conducted smoking cessation programs. Moreover, in the German-speaking realm, no publications exist about effective nursing interventions regarding smoking cessation. Thus, the aim of this article is to present an evidence based smoking cessation program offered by both nurses and physicians. Practice experiences indicate that the combination of nicotine substitution and counseling in several parts may be a successful interdisciplinary intervention.