Motivation and patch treatment for HIV+ smokers: a randomized controlled trial

Abstract

Aims: To test the efficacy of two smoking cessation interventions in a HIV positive (HIV+) sample: standard care (SC) treatment plus nicotine replacement therapy (NRT) versus more intensive motivationally enhanced (ME) treatment plus NRT.

Design: Randomized controlled trial.

Setting: HIV+ smoker referrals from eight immunology clinics in the northeastern United States.

Participants: A total of 444 participants enrolled in the study (mean age = 42.07 years; 63.28% male; 51.80% European American; mean cigarettes/day = 18.27).

Interventions: SC participants received two brief sessions with a health educator. Those setting a quit date received self-help quitting materials and NRT. ME participants received four sessions of motivational counseling and a quit-day counseling call. All ME intervention materials were tailored to the needs of HIV+ individuals.

Measurements: Biochemically verified 7-day abstinence rates at 2-month, 4-month and 6-month follow-ups.

Findings: Intent-to-treat (ITT) abstinence rates at 2-month, 4-month and 6-month follow-ups were 12%, 9% and 9%, respectively, in the ME condition, and 13%, 10% and 10%, respectively, in the SC condition, indicating no between-group differences. Among 412 participants with treatment utilization data, 6-month ITT abstinence rates were associated positively with low nicotine dependence (P = 0.02), high motivation to quit (P = 0.04) and Hispanic American race/ethnicity (P = 0.02). Adjusting for these variables, each additional NRT contact improved the odds of smoking abstinence by a third (odds ratio = 1.32, 95% confidence interval = 0.99-1.75).

Conclusions: Motivationally enhanced treatment plus NRT did not improve cessation rates over and above standard care treatment plus NRT in this HIV+ sample of smokers. Providers offering brief support and encouraging use of nicotine replacement may be able to help HIV+ patients to quit smoking.

Trial registration: ClinicalTrials.gov NCT00551720.

Figure 1

Participant flow through the screening, randomization, and follow-up processes.

Figure 2

Intent-to-Treat (ITT) quit rates over two-month, four-month, and six-month follow-up, by study condition and race/ethnic group. Note: ME = Motivationally-Enhanced Treatment; SC = Standard Care Treatment.