Receipt of Smoking Cessation Medications Among People With and Without Human Immunodeficiency Virus in the Veterans Aging Cohort Study (2003–2018)

Abstract

Background Nicotine replacement therapy (NRT), bupropion, and varenicline are smoking cessation medications (SCM) shown to be similarly effective in people with and without HIV (PWH and PWoH, respectively), though rates of receipt of these medications are unknown. Methods We identified patients in the Veterans Aging Cohort Study (VACS) with EHR-documented current smoking using clinical reminder data for tobacco use (2003-2018). We measured receipt of SCM using VA pharmacy data for outpatient prescriptions filled 0-365 days following current smoking documentation. We used log-linear Poisson-modified regression models to evaluate the relative risk (RR) for receiving SCM by HIV status, the annual rate of receipt, and rate difference among PWH relative to PWoH. Results The sample included 92,632 patients (29,086 PWH), reflecting 381,637 documentations of current smoking. From 2003 to 2018, the proportion receiving SCM increased from 15% to 34% for PWH and from 17% to 32% among PWoH. There was no statistical difference in likelihood of receiving SCM by HIV status (RR 1.010, 95% CI 0.994-1.026). Annual rates of receiving SCM increased for PWH by 4.3% per year (RR 1.043, 95% CI 1.040-1.047) and for PWoH by 3.7% per year (RR 1.037, 95% CI 1.036-1.038; rate difference +0.6% [RR 1.006, 95% CI 1.004-1.009]). Conclusions In a national sample of current smokers, receipt of SCM doubled over the 16-year period, and differences by HIV status were modest. However, fewer than 35% of current smokers receive SCM annually. Efforts to improve SCM receipt should continue for both groups given the known dangers of smoking.