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

描述(由申请人提供)：艾滋病毒/艾滋病患者(PLWH/A)吸烟的比例不成比例，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。俄勒冈州的艾滋病药物援助计划(ADAP)，即CAREAsset，通过帮助2100多名低收入PLWH/A患者获得医疗保险，并提供自付和处方药，为他们提供服务。2006年的调查数据显示，CAREAsset客户的吸烟率很高(42%)，但大多数吸烟者想戒烟(72%)，并对使用免费提供的戒烟药物感兴趣(83%)。意识到了这个机会，CAREAsset在2008年将戒烟药物疗法整合到了其药物处方中，向那些保险计划不会为此买单的客户免费提供戒烟药物疗法，该项目开始通过俄勒冈州烟草戒烟专线支付咨询费用。尽管消除了这些财务障碍，但2009年11月的初步数据表明，CAREAssists客户的吸烟率与2006年几乎没有变化。拟议项目的总体目标是提高对CAREAssists客户使用免费戒烟药物治疗和咨询服务的障碍的了解，以便为开发一种干预措施提供信息，该干预措施将把更多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CAREAssists客户的现有调查数据进行分析，并将对15名艾滋病毒病例经理、15名医疗提供者和45名CAREAssists客户进行深入访谈，以描述：1)目前吸烟、戒烟行为和使用处方药物治疗的情况，以及CAREAssists客户中的戒烟线，按人口统计数据、住房不稳定、药物滥用、总体身体健康、总体心理健康、并存疾病、坚持艾滋病毒治疗、向医疗提供者就诊、实际和社会支持以及他们的社交网络中的吸烟行为；2)客户层面的障碍，使用戒烟服务、接受药物治疗和成功戒烟；3)目前的HIV医疗提供者和HIV病例管理者关于戒烟的知识、态度和行为；4)HIV提供者、HIV病例管理者和在PLWH/A中筛查吸烟行为的系统级障碍，提供戒烟咨询和转诊，开出戒烟药物疗法，并将这些药物疗法整合到HIV治疗方案中。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了解。这些信息将被用来为制定干预措施提供信息，该干预措施将把额外的戒烟支持整合到俄勒冈州的艾滋病毒护理系统中，并可以在全国各地的ADAP人群中实施。 公共卫生相关性：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了解。这些信息将被用来为制定干预措施提供信息，该干预措施将把额外的戒烟支持整合到俄勒冈州的艾滋病毒护理系统中，并可以在全国各地的ADAP人群中实施。

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. PUBLIC HEALTH 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.