Grant Details
Grant Number: |
3R01CA261232-02S1 Interpret this number |
Primary Investigator: |
Rojewski, Alana |
Organization: |
Medical University Of South Carolina |
Project Title: |
Optimizing Tobacco Treatment Delivery for People Living with HIV Diversity Supplement |
Fiscal Year: |
2022 |
Abstract
Summary of the Parent Grant: With advances in antiretroviral therapy (ART), people living with HIV (PLWH)
are living longer, are more likely to die from non-AIDS-related causes, and are less likely to die from AIDS-
related complications. In fact, lung cancer is now the leading cause of cancer death among PLWH. Tobacco
use is a major contributing factor to lung cancer incidence and mortality among PLWH since smoking rates
among PLWH are approximately 40-50%. Indeed, this is more than double or triple the 15.5% rate of smoking
in the general United States population. With several evidence-based tobacco treatment approaches at the
patients’ disposal, including pharmacotherapy and behavioral counseling, optimizing how those treatments are
delivered to patients requires an empirical approach. Routine clinical care through the healthcare system may
not be optimized to reach this patient population. Prior research has shown that proactive tobacco treatment
increases the likelihood of treatment engagement and downstream cessation. Beyond the method for engaging
in the initial contact session, prior studies have demonstrated that there are optimal ways for framing how the
tobacco treatment is being provided. That is, presenting smoking cessation in an opt-out fashion results in
increased patient reach and likelihood of abstinence. Despite the evidence in support of a proactive, opt-out
method for smoking cessation intervention delivery, this strategy has not been evaluated in the context of
tobacco treatment for PLWH. Further, because this approach can connect patients with available, evidence-
based interventions that can be delivered remotely, it holds promise for implementation in the context of
healthcare settings across the country. In the proposed study, we will conduct a type 1 hybrid effectiveness-
implementation trial to evaluate the impact of a proactive, opt-out smoking cessation intervention on smoking
cessation outcomes and advance understanding of key barriers and facilitators of implementation processes.
We propose a comparison of Treatment As Usual [TAU; reactive, opt-in smoking cessation treatment delivered
through Infectious Diseases clinical pathways] to Proactive Outreach with Medication Opt-out for Tobacco
Treatment Engagement (PrOMOTE) and characterization of key determinants of PrOMOTE implementation
outcomes. The intervention will consist of a tobacco treatment specialist proactively and remotely contacting a
patient to assess smoking status, provide a brief motivational interview and counseling, and provide a mail-
order prescription for varenicline (or dual NRT if indicated) in an opt-out fashion. This proposed study will
examine this novel approach to optimizing delivery of smoking cessation care for PLWH. Integrating
effectiveness and implementation results will help define best practices for engaging PLWH with existing
evidence-based smoking cessation interventions. This hybrid effectiveness-implementation trial presents on
opportunity to optimize tobacco treatment delivery, and identify barriers and facilitators towards future
implementation and dissemination to ambulatory HIV clinics across the country.
Publications
None. See parent grant details.