Efficacy and acceptability of a combination intervention for smoking cessation in HIV positive individuals: a pilot study
HIV positive gay men have high rates of cigarette smoking. The risks of smoking in addition to the elevated risk of cardiovascular disease and some malignancies in people with HIV means smoking cessation interventions should be prioritised.
HIV positive individuals were referred by clinicians in the local area to a smoking cessation clinic established at RPA Sexual Health and offered a combination of nicotine replacement therapy (NRT ) and counselling. Demographic and behavioural data were collected, including an objective measurement of smoking (Smokalyzer) and a measurement of nicotine dependence (Fagerström score).
41 men aged 29-69 (median 46 years) were enrolled. More than half (51%) had been diagnosed with depression and less than one-third (30%) were currently employed. Participants had smoked for a median of 27 years (range 14-54 years), and mean number of cigarettes per day (CPD) smoked was 23 (range 4-50). Only 21 of 41 participants (51%) returned for at least one follow-up visit and 5 had successfully quit smoking. Successful quitting was associated with more years of smoking (p=0.031) and older age (p=0.060), but not baseline Fagerström score (p=0.582). Of participants who attended 6-month (n=18) and 12-month (n=16) follow-up, there was a significant decline in mean CPD from baseline (6-month:14 vs 27,p=0.003; 12-month:15 vs 26, p<0.001). Self-reported reduction in CPD was supported by Smokalyzer results at 6 months. 20/21 (95%) participants rated the intervention as helpful/very helpful. Participants identified the most helpful interventions as NRT (76%) and psychological support (71%).
Follow-up was poor in this disadvantaged population of HIV-positive men. Only 12% of participants were known to have quit smoking. Nonetheless, participants who attended follow-up significantly reduced their CPD and rated the intervention highly. Offering this service after-hours may improve attendance of a more diverse group of HIV positive individuals.
