This article by Michael Carter was first published in aidsmap.com here.
The provision of smoking cessation counselling and therapy during routine HIV care increases the chances that patients will stop smoking and stay stopped, according to Swiss research published in HIV Medicine.
Physicians at the Zurich HIV clinic received training about smoking cessation counselling and the use of medication to help those wanting to quit.
Compared to other patients in the Swiss HIV Cohort, people who received their care in Zurich were more likely to stop smoking and also less likely to restart smoking after they had quit.
The Zurich doctors were able to successfully integrate smoking cessation support into routine clinic appointments.
Cardiovascular disease is an increasingly important cause of illness and death in patients with HIV. The largest modifiable risk factor for cardiovascular disease is smoking. Compared to individuals in the general population, patients with HIV are significantly more likely to smoke.
Although a significant majority of all smokers wish to stop, only a minority succeed. Approximately a fifth of those trying to stop smoking receive specialist support in the form of counselling or supportive drug therapy. Doctors who have been trained how to support patients who wish to stop smoking are more likely to offer referrals to counsellors or prescribe supportive drug therapy.
Little information is available on how smoking cessation is handled in HIV care.
Therefore, between 2007 and 2009, all doctors at the HIV treatment centre in Zurich were provided with specialist training about the role of counselling and drug support in smoking cessation. The investigators hypothesised that the patients of these doctors would be more likely to stop smoking than patients at other HIV treatment centres in Switzerland.
The training lasted half a day and was provided by the Swiss Lung Foundation. It provided information on the identification of smokers, nicotine dependence, nicotine withdrawal, motivation stages, methods of counselling and pharmacological support.
A total of 1,689 patients received care at the Zurich treatment centre and 11,056 in the Swiss Cohort during the study.
No centre other than the Zurich clinic offered structured smoking cessation support.
Physicians at the Zurich clinic included smoking cessation in 80% of consultations for current smokers.
Prevalence of smoking in the entire Swiss Cohort fell from 60% in 2000 to 43% in 2010.
In 2000, 64% of patients in Zurich smoked. This had fallen by 23% by 2010, somewhat greater than the 16% decline recorded in the Swiss Cohort overall.
Just before the start of the study in 2007, the incidence of smoking cessation among the Zurich patients was 6.1 per 100 person years. This had increased to 10.8 per 100 person years in 2010. The corresponding figures for the Swiss Cohort were 4.4 and 6.2 per 100 person years respectively.
Incidence of relapse among former smokers at the Zurich clinic fell dramatically over the period of the study from 8.7 per 100 person years in 2007 to 2.9 per 100 person years in 2010. Incidence at other treatment centres were largely unchanged at 10.9 and 9.2 per 100 person years in 2007 and 2010.
The investigators calculated that patients at the Zurich clinic were approximately 25% more likely to stop smoking than patients receiving care at other Swiss centres (OR = 1.23; 95% CI, 1.07-1.42, p = 0.004). Patients in Zurich who managed to quit were also significantly less likely to start smoking again than patients at other centres (OR = 0.75; 95% CI, 0.61-0.92, p = 0.007).
The effect of the intervention remained significant even after controlling for calendar year.
Injecting drug users and heavy drinkers were significantly less likely to stop smoking (p < 0.001). So too were patients who were either undergoing psychiatric treatment or who had depression (p = 0.03). The same factors were associated with relapse after smoking cessation. In contrast, patients with a history of cardiovascular disease were less likely to relapse after quitting (p = 0.005).
“Smoking cessation should be a topic of discussion in any physician-patient contact,” conclude the investigators. “Our approach of an institution-wide training programme for infectious diseases physicians to improve smoking cessation counselling can be well integrated into routine HIV care, was well accepted by patients and physicians, and can support patients’ efforts to stop smoking.”
Huber B. Outcomes of smoking cessation counselling of HIV-positive persons by HIV care physicians. HIV Med, doi: 10.1111/j.1468-1293.2011.00984.x, 2012 (click here for the free abstract).