title: Outcome of smoking cessation counselling of HIV-positive persons by HIV care physicians.
abstract: OBJECTIVE
  Smoking is the most prevalent modifiable risk factor for cardiovascular diseases among HIV-positive persons. We assessed the effect on smoking cessation of training HIV care physicians in counselling.
  
  
  METHODS
  The Swiss HIV Cohort Study (SHCS) is a multicentre prospective observational database. Our single-centre intervention at the Zurich centre included a half day of standardized training for physicians in counselling and in the pharmacotherapy of smokers, and a physicians' checklist for semi-annual documentation of their counselling. Smoking status was then compared between participants at the Zurich centre and other institutions. We used marginal logistic regression models with exchangeable correlation structure and robust standard errors to estimate the odds of smoking cessation and relapse.
  
  
  RESULTS
  Between April 2000 and December 2010, 11 056 SHCS participants had 121 238 semi-annual visits and 64 118 person-years of follow-up. The prevalence of smoking decreased from 60 to 43%. During the intervention at the Zurich centre from November 2007 to December 2009, 1689 participants in this centre had 6068 cohort visits. These participants were more likely to stop smoking [odds ratio (OR) 1.23; 95% confidence interval (CI) 1.07-1.42; P=0.004] and had fewer relapses (OR 0.75; 95% CI 0.61-0.92; P=0.007) than participants at other SHCS institutions. The effect of the intervention was stronger than the calendar time effect (OR 1.19 vs. 1.04 per year, respectively). Middle-aged participants, injecting drug users, and participants with psychiatric problems or with higher alcohol consumption were less likely to stop smoking, whereas persons with a prior cardiovascular event were more likely to stop smoking.
  
  
  CONCLUSIONS
  An institution-wide training programme for HIV care physicians in smoking cessation counselling led to increased smoking cessation and fewer relapses.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Huber
authors.forename: B
authors.initials: B
authors.lastname: Ledergerber
authors.forename: R
authors.initials: R
authors.lastname: Sauter
authors.forename: J
authors.initials: J
authors.lastname: Young
authors.forename: J
authors.initials: J
authors.lastname: Fehr
authors.forename: A
authors.initials: A
authors.lastname: Cusini
authors.forename: M
authors.initials: M
authors.lastname: Battegay
authors.forename: A
authors.initials: A
authors.lastname: Calmy
authors.forename: C
authors.initials: C
authors.lastname: Orasch
authors.forename: D
authors.initials: D
authors.lastname: Nicca
authors.forename: E
authors.initials: E
authors.lastname: Bernasconi
authors.forename: R
authors.initials: R
authors.lastname: Jaccard
authors.forename: L
authors.initials: L
authors.lastname: Held
authors.forename: R
authors.initials: R
authors.lastname: Weber
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D006679:HIV Seropositivity / Q000150:complications*; D006801:Humans; D007318:Inservice Training; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications; D008875:Middle Aged; D009042:Motivation; D016017:Odds Ratio; D010817:Physician-Patient Relations; D010820:Physicians / Q000592:standards* / Q000639:trends; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D019966:Substance-Related Disorders / Q000150:complications; D013557:Switzerland / Q000453:epidemiology