Approximately 50% to 70% of people living with Human Immunodeficiency Virus (HIV)/Autoimmune Deficiency Syndrome (AIDS;PLWHA) are nicotine dependent smokers, and thus at increased risk for smoking-related morbidity and mortality. Effective smoking cessation strategies are urgently needed to reduce both the health burden of smoking on PLWHA and costs to society. Contingency management (CM) treatments are efficacious in reducing cigarette smoking in other populations, but to date there are no published studies on the use of CM for smoking cessation in PLWHA. PLWHA who smoke cigarettes will be recruited from a large urban HIV/AIDS treatment clinic. All participants will receive bupropion treatment for 12 weeks. In Phase 1 (weeks 1-4), participants will be randomly assigned to: 1) Brief counseling and bupropion treatment based on standard of care (SoC);or 2) SoC plus brief, high-magnitude prize reinforcement (CM) designed to enhance initiation of abstinence by providing prize incentives. In Phase 2 (weeks 5-12) we will then use a stepped care model to assign participants to a tailored treatment intervention based on whether they respond adequately to the treatment in Phase 1. Non-responders will be randomly assigned to one of two 8-week behavioral treatments: 1) continued weekly counseling and monitoring of smoking;or 2) continued counseling plus prize CM. Treatment responders will be randomly assigned to: 1) no additional behavioral treatment (consistent with SoC);or 2) 8-weeks of counseling and monitoring, plus low-magnitude prize CM. Smoking will be assessed at pre-treatment baseline, during treatment phases, and at 6- and 12-month follow-up points. Outcome measures during treatment will include longest duration of continuous abstinence and biologically verified reduction in smoking (cotinine and expired carbon monoxide). Long-term outcomes will include 7-day point-prevalence of cigarette smoking at each follow-up. We predict CM patients will reduce cigarette smoking more than non-CM conditions in each treatment phase. This study is highly innovative as it is the first to examine the use of CM and to use a stepped care model for smoking cessation among PLWHA. Tailoring smoking cessation treatment on the basis of patient outcome early in treatment may improve smoking cessation effectiveness, and ultimately may reduce healthcare costs and improve the overall health of PLWHA. Thus this project has a high public health significance.
This study will be one of the first to examine the efficacy of prize contingency management (CM) for cigarette smoking, and the first to study CM for persons living with HIV/AIDS. Further, this study will use a stepped-care model to more efficiently tailor treatments to patients on the basis of initial treatment response. If our interventions are effective, this study will lend support to the wider dissemination of CM approaches for promoting smoking abstinence.