Investigating How to Change Systems of HIV Care to Support Smoking Cessation

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DESCRIPTION (provided by applicant): People living with HIV/AIDS (PLWH/A) disproportionately smoke cigarettes, putting them at risk for many adverse health outcomes, yet little is known about how to tailor cessation interventions for PLWH/A. Oregon's AIDS Drug Assistance Program (ADAP), known as CAREAssist, serves more than 2,100 low-income PLWH/A by assisting them with health insurance coverage and providing co-pays and prescription drugs. Survey data from 2006 indicated that the smoking prevalence among CAREAssist clients was high (42%), but that most smokers wanted to quit (72%) and were interested in using medicines for stopping smoking if available at no cost (83%). Recognizing an opportunity, CAREAssist in 2008 integrated cessation pharmacotherapy into its drug formulary, making it available at no cost to clients whose insurance plans would not pay for them, and the program started paying for counseling through the Oregon Tobacco Quit Line. Despite the removal of these financial barriers, preliminary data from November 2009 suggests the smoking prevalence among CAREAssist clients is virtually unchanged from 2006. The overall goal of the proposed project is to improve understanding of barriers to CAREAssist clients using free cessation pharmacotherapy and counseling services in order to inform the development of an intervention that would integrate additional cessation support into the integrated HIV system of care in Oregon. Existing survey data on over 1200 CAREAssist clients will be analyzed and in-depth interviews will be conducted with 15 HIV case managers, 15 medical providers, and 45 CAREAssist clients to describe:1) current smoking, quit behaviors, and utilization of prescribed pharmacotherapies and the Quit Line among CAREAssist clients by demographics, housing instability, substance abuse, overall physical health, overall mental health, co-morbidities, adherence to HIV treatment, visits to medical providers, practical and social support, and smoking behaviors among their social networks; 2) client-level barriers to utilizing cessation services, taking pharmacotherapies, and successfully quitting smoking; 3) current HIV medical provider and HIV case manager knowledge, attitude, and practices regarding tobacco cessation; 4) HIV medical provider, HIV case manager, and system-level barriers to screening for smoking behaviors among PLWH/A, providing cessation counseling and referrals, prescribing cessation pharmacotherapies, and integrating these pharmacotherapies into HIV treatment regimens. Project relevance: PLWH/A disproportionately smoke cigarettes, putting them at risk for many adverse health outcomes, yet little is known about how to tailor cessation interventions for PLWH/A. The goal of the proposed project is to improve understanding of the barriers to Oregon AIDS Drug Assistance Program (ADAP) clients using free cessation pharmacotherapy and counseling services. This information will be used to inform the development of an intervention that would integrate additional cessation support into Oregon's HIV system of care and could be implemented with ADAP populations across the nation.