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Abstract
Background
Approximately 40-70% of people living with HIV/AIDS (PLWHA) in the US are current smokers. PLWHA who smoke are more susceptible to heart disease, tuberculosis, AIDS-related cancers, and non-AIDS related cancers. They are less likely to be virally suppressed. Additionally, among PLWHA who smoke, smoking takes more years off their life than the virus itself. The purpose of this study is to examine what smoking cessation treatments are being implemented at HIV programs in the US, and what external and organizational factors predict the availability of such services.
Methods
The Consolidated Framework for Implementation Research (CFIR) was used as a guide to develop a cross-sectional survey which was emailed to program managers at HIV organizations across the US. The survey assessed the availability of recommended behavioral and medical treatments for smoking cessation, as well as organizational and policy-level constructs. Regression analyses were run to assess these constructs’ predictive values for smoking cessation availability.
Results
Less than half (48%) of programs surveyed offered medical treatments. Approximately 61% offered intensive behavioral treatments. In the outer setting of the CFIR, funding from the Ryan White Care Act parts C and D, as well as revenue received from Medicaid managed care were significantly predictive of both total number of medications and intensive behavioral treatments for smoking cessation. In the internal setting, manager openness to the use of evidence based treatments (EBTs) and manager and staff attitudes toward smoking cessation were significant predictors of many behavioral treatments.
Conclusion
Future interventions should focus on empowering more Ryan White-funded centers to provide smoking cessation and on developing an organizational culture that is more open to EBTs and that prioritizes smoking cessation for PLWHA
Approximately 40-70% of people living with HIV/AIDS (PLWHA) in the US are current smokers. PLWHA who smoke are more susceptible to heart disease, tuberculosis, AIDS-related cancers, and non-AIDS related cancers. They are less likely to be virally suppressed. Additionally, among PLWHA who smoke, smoking takes more years off their life than the virus itself. The purpose of this study is to examine what smoking cessation treatments are being implemented at HIV programs in the US, and what external and organizational factors predict the availability of such services.
Methods
The Consolidated Framework for Implementation Research (CFIR) was used as a guide to develop a cross-sectional survey which was emailed to program managers at HIV organizations across the US. The survey assessed the availability of recommended behavioral and medical treatments for smoking cessation, as well as organizational and policy-level constructs. Regression analyses were run to assess these constructs’ predictive values for smoking cessation availability.
Results
Less than half (48%) of programs surveyed offered medical treatments. Approximately 61% offered intensive behavioral treatments. In the outer setting of the CFIR, funding from the Ryan White Care Act parts C and D, as well as revenue received from Medicaid managed care were significantly predictive of both total number of medications and intensive behavioral treatments for smoking cessation. In the internal setting, manager openness to the use of evidence based treatments (EBTs) and manager and staff attitudes toward smoking cessation were significant predictors of many behavioral treatments.
Conclusion
Future interventions should focus on empowering more Ryan White-funded centers to provide smoking cessation and on developing an organizational culture that is more open to EBTs and that prioritizes smoking cessation for PLWHA