1. Positively Quitting
PRESENTED BY
CHRIS HOWARD
LIFE+ PROGRAM MANAGER

3. Acknowledgements: T2
Mr Peter Watts – Former Health Education Officer (QPP)
 Associate Professor Coral Gartner
People Living with HIV throughout Queensland
Queensland Positive People
since 1989

4. Smoking and HIV – Why is it an issue?
Smoking is one of the most important causes of illness and death in PLHIV
Smoking increases the risk of lung cancer, heart disease, high blood pressure and stroke
HIV-positive smokers have a greater risk of lung cancer than other smokers
High rates of smoking among PLHIV
Ageing population of PLHIV- elevated risks
Source: T2
Queensland Positive People
since 1989

5. Tobacco use amongst PLHIV
HIV Futures 8 Snapshot (895 PLHIV 2015/2016 data)
213 participants (24.3%) who indicated they currently smoke daily
323 (36.9%) who had previously smoked daily but quit (60% of total sample smoke/d)
The 2013 National Household Drug Survey indicated that 12.8% of Australians smoke daily (Australian Institute of Health and Welfare, 2014)
Power, J, Thorpe, R, Brown, G, Lyons, A, Dowsett, GW, Lucke, J, (2016). HIV Futures 8: Health and Wellbeing of People Living with HIV. Melbourne: Australian Research Centre in Sex, Health and Society, La Trobe University T2
Queensland Positive People
since 1989

6. QPP- Smoking cessation interventions
Cessation And Relapse Prevention (CARP) Trial
(TOBACCO HARM REDUCTION WITH VAPORISED NICOTINE): PILOT STUDY OF NICOTINE PRODUCT PREFERENCES AMONG PEOPLE LIVING WITH HIV
One to one health education with case managers & Peer Navigators
Queensland Positive People
since 1989

7. QPP
2009 QPP developed ‘Positively Quitting’ to address high rates of smoking among QLD PLHIV
13 member working group comprising doctors, nurses, psychologists & health promotion officers- launched 2010
Goals:
To decrease the prevalence of tobacco smoking among PLHIV in Queensland
Reduce the burden of disease and the development of comorbidities linked to tobacco-related harms
Queensland Positive People
since 1989

8. QPP- Positively Quitting
Strategies:
Production of health promotion resources for PLHIV on quitting
Development of clinician resource packs including smoking cessation guidelines and pharmacotherapy update, patient resources and smoking cessation algorithm
Establishment of a reimbursement scheme to remove financial barriers for PLHIV to quitting with Nicotine Replacement Therapy (NRT)
The project aligned with models of shared care and assisted clinicians in the encouragement of quitting smoking among patients
Queensland Positive People
since 1989

9. QPP- Positively Quitting
Launched 2010 with promotion ending in 2017:
Social media channels (Facebook/blogs)
Newsletters (printed and online)/website
broadcasts to database (all stakeholders)
Reimbursements of up to $250 per person, per annum
Eligibility: PLHIV residing in Queensland with verification of HIV status from the applicant’s clinician/service provider
Validation of the therapy/treatment being chosen for reimbursement by clinician
Queensland Positive People
since 1989

10. QPP- Positively Quitting
Therapeutic Treatment Inclusions:
Any Nicotine Replacement Therapy (NRT) product - e.g. chewing gum, patches, lozengers, sprays, etc.
Oral (non-nicotine) therapeutic treatments - e.g. Champix (varenicline tartrate); Zyban (bupropion hydrochloride), as prescribed.
Self-Help Therapy Inclusions: Therapy aids chosen by the applicant (e.g. motivational quit smoking books and publications; self-guided CDs and DVD quit smoking packages, quit smoking workshops, etc.)
50% reimbursement for vaporiser product hardware (e.g. devices). Reimbursement for any form of e-liquid (vaporising fluid) is NOT considered *(banned by TGA, support for importation) updated May 2017
Recognition of the growing body of evidence that vaping was less harmful than combustible tobacco and in response to evaluation findings/focus groups
Queensland Positive People
since 1989

11. QPP- Positively Quitting Evaluation
Survey of smoking status and awareness and use of QPP’s Positively Quitting project among Queensland PLHIV 2015/2016 (5 year time point)
Aims:
Inform future development of our quit smoking support programs
Assist researchers at the University of Queensland to develop quit smoking support resources for PLHIV
Queensland Positive People
since 1989

12. QPP- Positively Quitting Evaluation- Results
Demographics
Respondents:
N=66
Year of diagnosis:
Range 1983 to (n=6), 1985 (n=5), 1998 (n=5), 2013 (n=5), 2015 (n=5)
Age:
(33%) respondents aged (27%) aged 35-44
Gender:
Majority male (95%)
Queensland Positive People
since 1989

13. QPP- Positively Quitting Evaluation- Results
Whether you currently smoke or not, did you ever smoke tobacco on a daily or weekly basis?
 YES  NO
Ever smoked 85% (n=56)
Never Smoked 15 % (n=10 excluded from further survey)
Queensland Positive People
since 1989

14. QPP- Positively Quitting Evaluation- results
How often do you currently smoke?
 Daily  How many cigarettes do you smoke in a day?
 Weekly  How many cigarettes do you smoke in a week?
 Less than once a week (e.g. monthly, yearly)?
I have quit smoking  How long ago did you stop smoking?_____________years OR _____________months
49% (n=27) Currently smoke (daily)
Daily number of cigarettes - mostly high per day (range 2 to 45 per day)
43% [n=24] Quit smoking and 50% (n=12) did so more than 2 years ago and 37% (n=9) who quit in the last 6 months  
Queensland Positive People
since 1989

15. QPP- Positively Quitting Evaluation- results
Of those that currently smoke:
Have you ever tried to quit smoking?
 YES, in the past 12 months 60% (n=-17)
YES, but more than 12 months ago 32% (n=9)
 NO, I have never tried to quit 7% (n=2)
Queensland Positive People
since 1989

16. QPP- Positively Quitting Evaluation – Results
Of those that currently smoke:
Have you ever tried to reduce smoking?
YES, in the past 12 months 72% (n=21)
YES, but more than 12 months ago 14% (n=4)
NO, I have never tried to reduce 14% (n=4)
People are making efforts to at least reduce
Queensland Positive People
since 1989

17. QPP- Positively Quitting Evaluation
Which of the following (if any) have you used to quit or reduce smoking (tick all that apply) 53 respondents
 Nicotine Replacement Therapy in the form of gum, patches, lozenges, mouth-spray, dissolvable oral strips, or inhalator NRT (60% [n=32])
 Electronic Cigarettes (also known as e-cigarette, e-shisha, vape pen, personal vaporiser) electronic cig (13% [n=7])
 Prescription Medication – e.g. Champix, Zyban, etc. Prescription meds (54% [n=29])
 Peer or other support groups / quit courses
Quitline (13 QUIT)
Smartphone app (e.g. myquit buddy) (13% [n=7])
Information or resources on the internet
QPP Positively Quitting Project – e.g. resources or quit therapy cost reimbursement
Other (please state
None of these apply - I did not use any therapy or support
Only 7% (n=4) used QPP Positively Quitting Resources/Reimbursements – suggesting low familiarity or uptake of the QPP quit support program.
Queensland Positive People
since 1989

18. QPP- Positively Quitting Evaluation
Did you discuss quitting smoking with a doctor or other health professional in the last 12 months?
YES 55% (n=29) had discussed quitting with their doctor
NO 45% [n=24] did not *(24 had quit)
If yes, who raised the topic of quitting smoking?
 Me 72% (n=21) raised the discussion with their doctor
 Doctor/health professional 27% [n=8] were doctor initiated discussions  
*level of awareness amongst PLHIV of the benefits of quitting
*increased education for PLHIV
Queensland Positive People
since 1989

19. QPP- Positively Quitting Evaluation
Are there any other types of services or support that you would you like to help you to quit smoking or stay quit?
 YES (If YES, Please comment in your own words below)  NO
78% (n=40) do not require any other supports to quit smoking. 
22% (n=11) seek additional support
lack of knowledge of what else might help
concerns with current standard NRT therapies causing side effects
Queensland Positive People
since 1989

20. QPP- Positively Quitting Evaluation
Would you be interested in participating in a clinical trial of ways to quit smoking or reduce the harms from smoking?
YES 56% (n=29)  NO   43% (n=23)
What quit therapies or harm reduction products would appeal to you to try in a clinical trial? (tick all that apply)
 Nicotine Replacement Therapy - e.g. gums, patches, lozenges, spray, tabs, inhaler, etc. 58%
 Prescription Medication – e.g. Champix, Zyban, etc. 58%
 Electronic Cigarettes containing nicotine 58%
 Electronic Cigarettes without nicotine 54%
 Printed self-help material 15%
 Web-based self-help material 19%
 Motivational and practical advice over the phone from a quit coach 23%
Queensland Positive People
since 1989

21. QPP- Positively Quitting
‘You may also be happy to hear that I am now officially cigarette free for over 2 weeks after reducing my habit from 20 per day over the course of the past few months.
I would also like to say that this scheme has significantly contributed towards these efforts as additional motivation. Thank you to you and QPP for the support.’
 Client feedback ; March
Queensland Positive People
since 1989

22. QPP- Positively Quitting Evaluation- Summary
50% of the sample had quit 50% had not quit
Of those that currently smoke the majority had either attempted to quit or reduce their smoking in the last 12 months
High level of appeal for electronic cigarettes (vaping) as with conventional methods
Willingness to participate in clinical trials
Low levels of awareness of Positively Quitting Project
Queensland Positive People
since 1989

23. QPP- Positively Quitting- future plans
Health promotion resources redrafted 2017
Ongoing participation and support of research (student placement)
Ongoing availability of reimbursements for NRT/Vaporisers/medications
To access Positively Quitting refer patients directly to QPP or through website ‘refer now’
All Positively Quitting resources are available at this link:
Queensland Positive People
since 1989

24. How to Refer to Life+ Life+ link Call us
Call us
(toll free outside Brisbane) or
Complete an online referral form at
Or download/ or fax the referral
form to
Or fax to
Queensland Positive People
since 1989