Repeat Behavioral Counseling, With and Without Combination Nicotine Replacement Therapy, for Smoking Cessation Among...

Repeating an intervention strategy consistent with the chronic disease care model has been demonstrated to be efficacious in improving cessation outcomes among smokers. However, evidence is lacking for repeat treatment outcomes among people with HIV (PWH) who smoke in low-resource settings. We evaluated outcomes among participants (n = 384) who were provided a second round of treatment after initial treatment failure in a randomized controlled trial of behavioral counseling (BC) with or without combination nicotine replacement therapy (nicotine patches and gum, cNRT). The primary outcome was self-reported smoking abstinence at 6 months after repeat treatment, biochemically verified using exhaled breath carbon monoxide (CO) and urine cotinine test. Secondary outcomes include smoking abstinence at 2 months after repeat treatment and smoking reduction, measured by changes in exhaled breath CO at 2 months and 6 months after repeat treatment. Overall, 35 (9%) participants were abstinent at 6 months post-repeat treatment, including 15 (8%) participants in the repeat BC group compared to 20 (11%) participants in the repeat BC + cNRT group. There was no significant difference in abstinence rates between repeat treatment groups (Chi Squared (χ²) = 0.23; p = 0.63), including after adjusting for potential confounders [adjusted risk ratio (aRR) = 1.16, 95% CI 0.39, 3.47; p = 0.79]. Although augmenting repeat treatment of BC with cNRT may not provide additional benefits for PWH with prior treatment failure in this population, PWH in this setting may benefit from a repeat treatment strategy of BC with or without cNRT.