Receipt, Predictors and Effectiveness of Smoking Cessation Medications among People Living with HIV (PLWH) in the National Veterans Health Administration

Thesis (Ph.D.)--University of Washington, 2022Cigarette smoking is the leading cause of morbidity and mortality worldwide, and is highly prevalent among people living with HIV (PLWH). Prescription pharmacotherapies—nicotine replacement therapy (NRT), varenicline, and bupropion—have been shown to be comparably effective in promoting smoking cessation for PLWH and HIV-uninfected persons, and are recommended by the Veterans Health Administration (VHA) to treat tobacco use disorder. We used data from the Veterans Aging Cohort Study (VACS), which is the largest epidemiologic study of PLWH receiving health care in the United States, to specifically test: (1) whether PLWH are less likely to receive smoking cessation medications compared with HIV-uninfected individuals, and which patient-level factors are associated with receipt; (2) whether rates of medication receipt among PLWH and uninfected controls have changed over time; and (3) whether and which medications are most effective for smoking cessation among PLWH in routine care. Our findings were: (1) PLWH in a cross-sectional analysis were less likely to receive NRT, but not other medications; contemplating cessation and recent diagnoses for pulmonary disease and psychiatric illness were associated with receipt of smoking cessation medication among PLWH, but sociodemographic characteristics, alcohol use, substance use, or recent CVD diagnosis were not; (2) the rate of change in receiving any medication per year improved for both populations, largely due to greater receipt of NRT; PLWH experienced a slightly greater increase in rate of receiving medications; and (3) bupropion and varenicline were associated with increased likelihood of smoking cessation, but were underutilized as treatments for tobacco use disorder in the VHA; single NRT was not associated with smoking cessation and combination NRT was associated with continuing to smoke. In summary, smoking cessation may be promoted and health improved among PLWH by providing this population greater access to the most effective treatments for tobacco use disorder. The results of this innovative research could be used to better inform HIV service providers and policies within the VHA to fill gaps in care and deliver effective and tailored smoking interventions to their patients