Adherence trajectories to nicotine replacement therapy among people living with HIV in Uganda: A secondary analysis of the Quit4Life+ randomized controlled trial.

Abstract

Introduction: Nicotine replacement therapy (NRT) is an evidence-based approach to tobacco cessation, yet little is known about adherence to NRT among people living with HIV (PLWH) in Sub-Saharan Africa. This study aimed to identify NRT adherence trajectories among PLWH in Uganda and examine both baseline predictors and the role of SMS-delivered support in shaping adherence over time.

Methods: We conducted a secondary analysis of longitudinal data from 200 PLWH, aged ≥18 years with urine cotinine-verified tobacco use and randomized to receive NRT in the Ugandan sites (West Nile and Karamoja regions) of the Quit4Life+ trial, conducted between September 2023 and March 2026. NRT adherence was measured at weeks 2, 6, and 10 using self-reported days of NRT-patch (non)-use and using group-based trajectory modeling to identify adherence patterns. Multinomial logistic regression was used to examine the predictors of trajectory membership. Cross-lagged panel models were used to assess the temporal relationship between perceived stay-quit support and adherence.

Results: Three adherence trajectories emerged: a group with constant adherence (64.1%), a group with improving adherence (13.5%), and a group with worsening adherence (22.4%). High nicotine dependence predicted membership in the group with worsening adherence (adjusted relative risk ratio, ARRR=4.40; 95% CI: 1.92-10.04). Greater perceived stay-quit support was associated with lower odds of worsening-adherence (ARRR=0.39; 95% CI: 0.18-0.86), while more positively perceived message tone was associated with improving-adherence (ARRR=6.60; 95% CI: 1.39-31.26). Cross-lagged analyses showed that early stay-quit support predicted subsequent adherence, whereas adherence did not predict later perceptions of support.

Conclusions: Although baseline characteristics can help identify PLWH at risk of suboptimal adherence, the early weeks of treatment emerged as a potentially important window during which perceived SMS support preceded and predicted subsequent adherence. Combining early risk identification with timely, positively framed SMS support may hold promise for sustaining NRT adherence and could inform future adherence interventions.