Improving adherence to smoking cessation medication among PLWHA

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DESCRIPTION (provided by applicant): Smoking rates among people living with HIV/AIDS (PLWHA) are two to three times that of the general population. Due to treatment advances, PLWHA are living longer making the issue of cigarette smoking in this population a significant clinical concern. Despite the overwhelming burden of tobacco use, few studies have evaluated the delivery of smoking cessation interventions among PLWHA. Results from the sparse literature are mixed but suggest that PLWHA are interested in quitting and can achieve abstinence, particularly when pharmacotherapy such as nicotine replacement (NRT) is utilized. However, similar to findings in the general population, adherence to NRT among PLWHA is low. Given the strong evidence that combining behavioral therapy and pharmacotherapy is more effective than either alone, and that higher rates of NRT adherence are strongly associated with an increased likelihood of smoking cessation, poor NRT adherence poses a serious threat to treatment effectiveness and may negatively impact cessation outcomes. Yet adherence to smoking cessation medication has received remarkably little attention. For PLWHA, several potential barriers to NRT adherence have been described including an already complex medication regimen and negative beliefs about NRT. In order to reduce smoking-related health disparities within this underserved population it is critical that cessation interventions be developed that include strategies to improve treatment adherence. The R34 mechanism provides a unique opportunity to refine and pilot test a theory-driven smoking cessation intervention that enhances existing behavioral approaches by testing the impact of text message reminders to take NRT and the feasibility and additional impact of including NRT adherence-focused behavioral cessation counseling. We propose to randomize 190 participants, recruited from two HIV/AIDS clinic, to a three arm study that compares: 1) Standard Care (SC), 2) SC + text message reminders, and 3) SC + text message reminders + cell phone-delivered NRT adherence-focused behavioral therapy (ABT). Participants in all three arms will receive NRT for eight weeks. The primary outcomes are adherence to NRT and biochemically validated smoking abstinence at 8 weeks and 3-month follow-up. The primary aims are: 1) to determine the feasibility and acceptability of conducting a telephone delivered cessation counseling and text message intervention among a HIV+ clinic-based population, 2) to estimate and compare the effect of three models of smoking cessation treatment on NRT adherence and smoking abstinence at end of treatment (8 weeks) and 3-month follow-up. The secondary aims are to 1) to explore the relationship between NRT adherence and smoking cessation at end of treatment and 3 months and 2) to explore potential mediators of the intervention effect on NRT adherence. We expect that findings from the proposed study will lay the groundwork for a larger randomized trial that will provide a model for how to overcome barriers to smoking cessation in this population.