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

描述（由申请人提供）：艾滋病毒/艾滋病（PLWH/A）感染者不成比例地吸烟，使他们面临许多不良健康后果的风险，但对如何为PLWH/A定制戒烟干预措施知之甚少。俄勒冈州的艾滋病药物援助计划（ADAP），被称为CAREAssist，为2,100多名低收入PLWH/A提供医疗保险，并提供共同支付和处方药。2006年的调查数据表明，CAREAssist客户的吸烟率很高（42%），但大多数吸烟者希望戒烟（72%），并有兴趣使用免费的戒烟药物（83%）。认识到这是一个机会，CAREAssist在2008年将戒烟药物治疗纳入其药物处方，使其免费提供给那些保险计划不支付费用的客户，该计划开始通过俄勒冈州戒烟热线支付咨询费用。尽管消除了这些财政障碍，但2009年11月的初步数据表明，CAREAssist客户的吸烟率与2006年相比几乎没有变化。拟议项目的总体目标是提高对CAREAssist客户使用免费戒烟药物治疗和咨询服务的障碍的理解，以便为制定干预措施提供信息，该干预措施将额外的戒烟支持纳入俄勒冈州的综合艾滋病毒护理系统。将对1200多名CAREAssist客户的现有调查数据进行分析，并与15名艾滋病毒病例管理人员，15名医疗提供者和45名CAREAssist客户进行深入访谈，以描述：1）目前吸烟，戒烟行为，以及CAREAssist客户中处方药物治疗和戒烟热线的使用情况，包括人口统计学，住房不稳定性，药物滥用，整体身体健康，整体心理健康，合并症，对艾滋病毒治疗的坚持，医疗服务提供者的访问，实际和社会支持，（1）艾滋病患者在社交网络中的吸烟行为;（2）患者使用戒烟服务、接受药物治疗和成功戒烟的障碍;（3）目前的艾滋病医疗提供者和艾滋病病例管理者对戒烟的知识、态度和实践; 4）艾滋病医疗提供者、艾滋病病例管理者和系统层面的障碍，阻碍了艾滋病病毒感染者/艾滋病病毒携带者吸烟行为筛查、提供戒烟咨询和转诊、开具戒烟药物治疗处方以及将这些药物治疗纳入艾滋病病毒治疗方案。 项目相关性：PLWH/A不成比例地吸烟，使他们面临许多不良健康后果的风险，但人们对如何为PLWH/A量身定制戒烟干预措施知之甚少。拟议项目的目标是提高对俄勒冈州艾滋病药物援助计划（ADAP）客户使用免费戒烟药物治疗和咨询服务的障碍的理解。这些信息将用于制定干预措施，将额外的戒烟支持纳入俄勒冈州的艾滋病毒护理系统，并可在全国范围内与ADAP人群一起实施。

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.