Effectiveness of a Smoking Cessation Algorithm Integrated Into HIV Primary Care

Smoking remains the leading cause of preventable death and disability in the United States.
Whereas smoking has declined significantly among individuals in the general population, it is
clustered in populations of vulnerable individuals such as people living with HIV/AIDS (PLWH)
in whom smoking prevalence rates and resulting comorbidity rates remain high. Medical
advances in the treatment of HIV have resulted in substantial increases in life expectancy
among PLWH and as a consequence PLWH smokers are now, more than ever, at heightened risk for
tobacco-related illnesses and death. PLWH smokers engaged in treatment lose more years of
life due to smoking now than to HIV disease. Although PLWH smokers engaged in HIV care
typically see a medical provider every 4-6 months, smoking cessation treatment and referral
is often not part of routine HIV care. While 94% of HIV treatment providers indicated that
they would be willing to provide smoking cessation services to their patients, few have
received training in how to provide smoking cessation services. With seven first line
pharmacotherapies available for smoking cessation, development of algorithms to assist
providers in selecting the most appropriate pharmacotherapy is an important but untested
strategy to increase smoking cessation in PLWH. The purpose of this proposal is to conduct a
mixed efficacy/effectiveness trial comparing an algorithm treatment with prescription cost
off sets and quit line referral (AT) to an enhanced Treatment as Usual (quit line referral
only; eTAU) group. Six hundred PLWH smokers will be recruited at the University of Alabama at
Birmingham, University of Washington, and Fenway Health HIV clinics and will be randomized to
receive AT or eTAU. All AT smokers will receive active treatment for twelve weeks regardless
of stated motivation or intention to quit. eTAU smokers will be referred to quit line
services and HIV providers may elect to treat smoking as part of standard of care.
Participants will remain in the study for 12 months.

Inclusion Criteria:

1. Enrollment in the CNICS clinical cohort.

2. 18 years or older;

3. Receiving HIV care at the UAB, UW or Fenway Health clinics and not anticipating
changing clinics over the next six months

4. Smoking greater than or equal to 5 cigarettes per day (cpd) for the past month

5. Living in an unrestricted environment that allows smoking.

Exclusion Criteria:

1. Cognitive impairment such that unable to provide informed consent;

2. Non-English speaking;

3. Acutely suicidal, manic, acutely intoxicated, or otherwise not stable enough to
provide informed consent;

4. Currently receiving smoking cessation treatment.