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

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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.