Improving Nicotine Patch Adherence Among Latino HIV-Positive Smokers

描述(由申请人提供)：吸烟在艾滋病毒/艾滋病患者(PLWHA)中的流行率是普通人群的三倍。不幸的是，PLWHA缺乏有效的戒烟计划。在这一领域的第一代工作中，为数不多的大规模戒烟试验大多是提供尼古丁贴片的短暂干预。虽然没有发现一种特定的治疗方法对PLWHA特别有效，但这项工作的一个关键发现是，如果不遵守规定使用贴片，个人的戒烟结果会更差。PLWHA更普遍地发现，在HAART后的世界中，保持充分遵守他们的高强度医疗和用药方案是具有挑战性的。在这种情况下，将戒烟治疗与一种新的药物(例如尼古丁贴片)结合起来，而没有针对改善依从性的治疗成分的好处，可能注定要失败。这表明，PLWHA的第二代临床研究需要在短暂治疗的情况下改善对尼古丁贴片的依从性。该项目的具体目标是：(1)与曾使用尼古丁贴片的PLWHA吸烟者进行4个焦点小组(N=32)，以揭示贴片依附的障碍和促进器；(2)为PLWHA吸烟者(N=24)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，以更好地了解坚持和不坚持的过程；(3)基于AIMS 1-2的调查结果，制定以坚持为重点的干预措施，并与PLWHA吸烟者进行另外4个焦点小组(N=32)，以完善干预措施并确保其在人群中的可接受性；以及(4)进行一项先导性研究(N=48)，以比较标准的短暂戒烟治疗和尼古丁贴片(标准)与专注于依从性的短暂戒烟治疗和尼古丁贴片(依从性)在点位患病率、吸烟状态和贴片依从性方面的差异。这项拟议的研究是第一次开发一种简短的、以坚持为重点的戒烟治疗，针对PLWHA吸烟者的需求，并完全整合到他们现有的临床护理中。

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.