If varenicline cannot be used, this would be second line of treatment. This would require patients to have interest in quitting and be willing to take medicine.

New Mexico Highlands University

Algorithmic-Derived Treatment (AT) for Smoking Cessation

Cropsey, K. L., Jardin, B. F., Burkholder, G. A., Clark, C. B., Raper, J. L., & Saag, M. S. (2015). An Algorithm Approach to Determining Smoking Cessation Treatment for Persons Living With HIV/AIDS: Results of a Pilot Trial. Journal of acquired immune deficiency syndromes (1999), 69(3), 291–298. https://doi.org/10.1097/QAI.0000000000000579

An Algorithm Approach to Determining Smoking Cessation
Treatment for Persons Living With HIV/AIDS:
Results of a Pilot Trial


Strategies discussed include considering reasons to quit, coping strategies to deal with risky situations, informing others of intentions to quit, removing tobacco-related products from the home, and pharmacotherapy treatments as needed. 

Counseling to Quit Smoking

Varenicline is first line of treatment as it leads to higher quit rates than other single pharmacotherapy agents. This would require patients to be willing to take medicine twice a day and have interest in quitting.

Varenicline in AT for Smoking Cessation

Bupropion in AT for Smoking Cessation

These contain small amounts of nicotine to help with smoking cessation. This is third agent if varenicline and bupropion cannot be used. Within this, the first option offered is nicotine patch, followed by lozenge, gum, inhaler, and nicotine nasal spray in that specific order. This was developed based on  patient’s familiarity with the treatment and successful clinical trials. 

Single Nicotine Replacement Therapy (NRT) in AT for Smoking Cessation

NRT can be offered if no contraindications to use in instances when they are not allowed to smoke or if they wanted to reduce their smoking.  This can increase interest in quitting. 

Assisting Disinterested Patients in AT for Smoking Cessation

If they were already prescribed a single agent, they get offered an supplementary pharmacotherapy agent, typically a nicotine lozenge for acute cravings. 

Four Week Follow-up in AT for Smoking Cessation

Compared to treatment as usual (TAU), which involves the medical provider assisting the patient when they are ready to quit, with AT, cigarettes smoked per day (CPD) reduction was more (AT: 10 CPD reduction vs. TAU: 6 CPD reduction).  More participants with AT used medications for their treatments at 81% than TAU at 23%.

Behavioral Outcomes of AT for Smoking Cessation

Participants with AT reported more motivation at population mean = 8.93 compared to TAU population mean = 8.61 and lower perception of quitting difficulty at population mean = 4.64 and population mean = 5.46.

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