Improving Nicotine Patch Adherence Among Latino HIV-Positive Smokers

描述（由申请人提供）：吸烟在艾滋病毒/艾滋病（PLWHA）感染者中的流行程度是普通人群的三倍。不幸的是，目前缺乏针对艾滋病患者的有效戒烟规划。在这一领域的第一代工作中，为数不多的大规模戒烟试验主要是提供尼古丁贴片的短暂干预。虽然没有发现任何一种特定的治疗方法对艾滋病毒感染特别有效，但这项工作的一个关键发现是，如果个人没有按照规定使用贴片而不坚持戒烟，那么他们的戒烟结果会更差。艾滋病毒感染者普遍认为，在抗逆转录病毒治疗后的世界中，保持充分遵守其高度强化的医疗和药物治疗方案是一项挑战。在这种情况下，用一种新的药物（如尼古丁贴片）来增加戒烟治疗，而没有针对改善依从性的治疗成分的好处，可能注定会失败。这表明，与PLWHA的第二代临床研究需要在短暂治疗的背景下提高对尼古丁贴片的依从性。该项目的具体目标是：(1)对曾经使用过尼古丁贴片的PLWHA吸烟者进行4个焦点小组（N=32），以发现贴片依从性的障碍和促进因素；(2)为24名PLWHA吸烟者提供简短的戒烟咨询和尼古丁贴片治疗，并在2个月的时间内仔细跟踪他们的戒烟尝试，以更好地了解依从性和不依从性的发生过程；(3)基于目标1-2的发现，制定一项以依从性为重点的干预措施，并对PLWHA吸烟者进行4个额外的焦点小组（N=32），以完善干预措施并确保其在人群中的可接受性；(4)进行一项试点研究（N=48），比较标准的短暂戒烟治疗和尼古丁贴片（standard）与以坚持为重点的短暂戒烟治疗和尼古丁贴片（依从性）在点流行吸烟状况和贴片依从性方面的差异。这项拟议的研究首次开发了一种简短的、以坚持为重点的戒烟治疗方法，该治疗方法针对PLWHA吸烟者的需求，并充分纳入其现有的临床护理。

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.