An Algorithm Approach to Determining Smoking Cessation Treatment for Persons Living With HIV/AIDS

Abstract

Background Smoking now represents one of the biggest modifiable risk factors for disease and mortality in PLHIV. To produce significant changes in smoking rates among this population, treatments will need to be both acceptable to the larger segment of PLHIV smokers as well as feasible to implement in busy HIV clinics. The purpose of this study was to evaluate the feasibility and effects of a novel proactive algorithm-based intervention in an HIV/AIDS clinic. Methods PLHIV smokers (N =100) were proactively identified via their electronic medical records and were subsequently randomized at baseline to receive a 12-week pharmacotherapy-based algorithm treatment or treatment as usual. Participants were tracked in-person for 12-weeks. Participants provided information on smoking behaviors and associated constructs of cessation at each follow-up session. Results The findings revealed that many smokers reported utilizing prescribed medications when provided with a supply of cessation medication as determined by an algorithm. Compared to smokers receiving treatment as usual, PLHIV smokers prescribed these medications reported more quit attempts and greater reduction in smoking. Proxy measures of cessation readiness (e.g., motivation, self-efficacy) also favored participants receiving algorithm treatment. Conclusions This algorithm-derived treatment produced positive changes across a number of important clinical markers associated with smoking cessation. Given these promising findings coupled with the brief nature of this treatment, the overall pattern of results suggests strong potential for dissemination into clinical settings as well as significant promise for further advancing clinical health outcomes in this population.

Lung cancer in persons with HIV

“…In a recent meta-analysis of randomized controlled trials evaluating behavioral interventions for tobacco use in HIV infected smokers these interventions, particularly those with eight or more sessions, had a modest but significant effect on smoking cessation[67]. Pharmacologic agents that have shown smoking cessation efficacy in the general population, including varencycline, buproprion and nicotine replacement therapy, have also been evaluated in HIV infected smokers as part of smoking cessation programs with evidence of safety and efficacy[64, 68–70]. …”

Tobacco Use, Use Disorders, and Smoking Cessation Interventions in Persons Living With HIV

“…Two recent trials by Cropsey and colleagues [48, 49] examined non-abstinence-related smoking primary endpoints following an intervention. In a pilot study [48], smokers with HIV were randomized to receive 8-weeks of combination NRT (i.e., 14 mg nicotine patches and 2 mg nicotine lozenges) plus brief counseling (i.e., Screening, Brief Intervention, and Referral for Treatment [SBIRT]), or NRT plus usual care.…”

“…After 8 weeks of follow up, participants in the NRT plus SBIRT group reported significantly decreased CPD, nicotine dependence as measured by the Fagerström Test for Nicotine Dependence, smoking urge, and smoking withdrawal symptoms, even among smokers who reported not being ready to quit within the next 6 months. Most recently, Cropsey and colleagues [49] tested an algorithm-based model of smoking cessation, in which participants were randomized to receive 12-weeks of pharmacotherapy for cessation (i.e., varenicline, bupropion, nicotine patch, nicotine lozenge, or combination NRT) as determined by an algorithm, as compared to those receiving treatment as usual. Outcomes of the algorithm were based on a variety of factors including: 1) current interest in quitting; 2) willingness/ability to take medications; 3) contraindications for cessation treatments (i.e., suicidal ideation, pregnancy, other medications); 4) prior history with various cessation treatments.…”

Smoking Cessation for People Living With HIV/AIDS: A Literature Review and Synthesis

“…Chew et al 44 reported 16% self-reported 7-day point prevalence rates at their 6-month follow-up for PLWHA who participated in a single counseling session and were prescribed pharmacotherapy. Finally, Cropsey et al 45 noted that smokers who underwent brief counseling and an algorithm-based intervention designed to provide appropriate level of care based on patient motivation to quit and indications for medication treatments reported greater reductions in selfreported cigarettes smoked per day and a greater number of 24-hour quit attempts over treatment and 1-month follow-up compared with patients who received usual care.…”