Improving Nicotine Patch Adherence Among Latino HIV-Positive Smokers

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DESCRIPTION (provided by applicant): Cigarette smoking is three times more prevalent among people living with HIV/AIDS (PLWHA) than in the general population. Unfortunately, efficacious smoking cessation programs for PLWHA are lacking. The few large-scale smoking cessation trials that characterized the first generation of work in this area were mostly brief interventions with provision of the nicotine patch. While no one particular treatment approach was found to work especially well with PLWHA, a key finding of this work was that individuals had worse smoking cessation outcomes if they were non-adherent by failing to use the patch as prescribed. PLWHA more generally find it challenging to maintain adequate adherence to their highly intensive medical and medication regimens in the post-HAART world. In this context, adding smoking cessation treatment with a new medication (e.g., nicotine patch) without the benefit of a component of treatment targeted at improving adherence may have been destined to fail. This suggests that the second generation of clinical research with PLWHA needs to improve adherence to the nicotine patch within the context of brief treatment. The specific aims of this project are to: (1) conduct 4 focus groups (N=32) with PLWHA smokers who have ever used the nicotine patch to uncover barriers and facilitators of patch adherence; (2) provide brief cessation counseling and nicotine patch treatment to PLWHA smokers (N=24) and carefully track their quit attempt over a 2-month period to better understand the process through which adherence and non-adherence occurs; (3) based on findings from Aims 1-2, develop an adherence-focused intervention and conduct 4 additional focus groups (N=32) with PLWHA smokers to refine the intervention and ensure its acceptability in the population; and (4) conduct a pilot study (N=48) to compare a standard brief smoking cessation treatment and nicotine patch (STANDARD) to the adherence-focused brief smoking cessation treatment and nicotine patch (ADHERENCE) in terms of point-prevalence smoking status and patch adherence. The proposed study is the first to develop a brief, adherence-focused smoking cessation treatment that is targeted to the needs of PLWHA smokers and fully integrated into their existing clinical care.