Preloading With Nicotine Replacement Therapy in HIV-positive Smokers to Improve Self-Efficacy and Quit Attempts

Cigarette smoking is more prevalent in persons with HIV (PWH) in the U.S. when compared

with the general population and is linked to increased morbidity and mortality in this

population. Furthermore, HIV-positive smokers have increased rates of lung and other

smoking-related cancers. Smokers with HIV are a particularly challenging group, often

reporting high severity of nicotine dependence and low rates of self-efficacy for

quitting, both factors related to poor smoking cessation outcomes. Establishing more

effective smoking cessation approaches for smokers with HIV, particularly those that

address low self-efficacy and severe dependence, is a public health priority. The overall

goal of this research project is to examine the feasibility, acceptability, and

preliminary efficacy of nicotine replacement therapy preloading (NRT-P) in HIV-positive

smokers, who are struggling with cigarette dependence, urge to smoke (craving) and low

self-efficacy as barriers to successful smoking cessation. Sixty participants will be

recruited into a 12-week randomized pilot study. Thirty participants (control condition)

will receive standard smoking cessation counseling (NRT-S) and will initiate an 8-week

course of combination nicotine patch and lozenge on quit date (week 4), consistent with

recommended guideline based on smoking rate. Thirty participants (active condition) will

start NRT patch 3 weeks prior to quit date, followed by an 8-week course of combination

nicotine patch and lozenge, initiated on quit date. Dependence, urge to smoke and

self-efficacy for quitting prior to and following quit date will be examined. Differences

in quit attempts and biochemically validated smoking abstinence between the control and

active conditions at weeks 8 and 12 will also be examined. This study will be the first

to examine the feasibility and initial efficacy of a novel intervention using NRT

preloading to improve smoking cessation outcomes in PWH. Given the high prevalence of

smoking and the significant morbidity associated with it in PWH, the development of

effective strategies to reduce the risks related to smoking in this group is critical. If

determined to be effective, this intervention could be readily disseminated in HIV

clinics. This study will provide key information on the potential benefit of NRT

preloading in a population that is highly dependent on nicotine and highly vulnerable to

smoking-related morbidity and mortality.