MOTIVATION AND PATCH TREATMENT FOR HIV POSITIVE SMOKERS

Miriam Hospital, Providence RI

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Abstract

Treatments for persons who are infected with the Human Immunodeficiency virus (HIV) or who have developed AIDS have advanced to there point where death is no longer the most likely outcome of a diagnosis. Combination anti-retroviral therapies and treatments with protease inhibitors have made HIV-infection a manageable, chronic conditions. Efforts to improve the health and quality of life of persons living with AIDS or who are HIV- positive is therefore a high priority. Cigarette smoking posses several health risks that are unique to the HIV-positive population, including increased risk of bacterial pneumonia, oral candidiasis, and perhaps even increased risk for progression to full-blown AIDS. Clearly, quitting smoking would help to improve these risk profiles. However, to date, no clinical research studies have been conducted to evaluate the effectiveness of stop smoking treatments specifically tailored to the HIV- positive population of smokers. In a additive design, this proposal will evaluate two treatments for smoking cessation in four outpatient clinics which treat HIV-infected persons. The goal is to enroll all eligible smokers, regardless of their motivation to quit smoking, into the study. Patients randomized into the Brief Treatment condition will receive from their physician a stop smoking intervention, following NCI guidelines from brief smoking cessation counseling. They will also receive a prescription for the nicotine patch. One follow-up visit will be scheduled between the physician and patient to check on their progress at quitting smoking. Patients randomized into the Motivational Enhancement condition will receive on their progress in quitting smoking. Patient randomized into the Motivational Enhancement condition will receive the above, in addition to two in-person visits (over a two month period, to coincide with the patient's regular clinic visits) with a trained Health Educator who will tailor the cessation intervention to the patient's level of motivation to quit smoking. All patients will be followed for a 2-, 4-, and 6-month follow-up. Point prevalence smoking status (7-day, CO verified) at the 6-month point will be the primary outcome of interest. We hypothesize that 9% of the Motivational Enhancement patients will have quit smoking at this point, compared to 3% to patients in the Brief treatment condition. A number of important mediators of treatment outcome (e.g., self-efficacy, motivation decisional balance) also will be examined and the cost effectiveness of the treatments will be evaluated. This study will be the first to examine different smoking cessation treatments in an HIV-positive population and the results will have implications for important cost effective cessation interventions into clinical care settings.