Study aims to refine delivery of tobacco treatment to people with HIV

Researchers at MUSC Hollings Cancer Center have received more than $2 million from the National Cancer Institute (NCI) to evaluate the impact of a proactive opt-out approach to smoking cessation on the health outcomes of people living with HIV.

The project, led by Hollings Cancer Control Program researcher Alana Rojewski, Ph.D., is designed to define best practices for connecting and engaging people with HIV with existing evidence-based interventions that can help them to quit smoking. The study will also look at barriers to current intervention strategies and ways to increase the number of people receiving tobacco treatment.

Roughly 40% to 50% of people with HIV smoke - a rate that's more than double or triple the 15.5% smoking rate that exists in the general U.S. population. This high rate of tobacco use is a major contributing factor to lung cancer incidence and mortality among people with HIV. Lung cancer is now the leading cause of cancer deaths in this population.

Advances in antiretroviral therapy mean people with HIV are living longer and are less likely to die from AIDS-related complications. A recent study found that people with HIV who adhered to their antiretroviral therapy and continued to smoke were six to 13 times more likely to die from lung cancer than AIDS-related causes.

According to Rojewski, this shift means a greater focus is needed on non-AIDS-related health conditions in this population, including lung cancer and other smoking-related complications.

"There are numerous sociodemographic factors that contribute to the high rate of smoking among people with HIV, including race, education level, socioeconomic status and other medical and psychiatric comorbidities. This can be partly attributed to decades of aggressive marketing by the tobacco industry toward these populations, and we are still seeing the ramifications in terms of high rates of smoking and associated health complications," said Rojewski, associate director of MUSC Health's Tobacco Treatment Program.

"By studying how we are delivering tobacco treatment to people with HIV, this study will provide critical evidence to refine delivery and implementation strategies and holds promise for future dissemination to clinics in South Carolina and across the nation."

Instead of waiting for people with HIV who smoke to seek treatment for their tobacco use, the intervention used in this study will consist of a tobacco treatment specialist proactively contacting all patients to assess smoking status. The treatment specialist will then provide a brief motivational interview and counseling and a mail-order prescription for varenicline, a medication used to treat nicotine addiction, or dual-form nicotine replacement therapy.

The intervention will use an opt-out approach, meaning all patients who smoke will receive treatment unless they indicate that they don't want it. Because the intervention will be done entirely remotely, the researchers hope the approach will make evidence-based smoking cessation treatments available to more people with HIV in health care settings across the country.

Prior research has shown that proactive tobacco treatment increases the likelihood of treatment engagement and downstream cessation. Offering cessation treatment in an opt-out fashion also has been shown to increase patient reach and the likelihood that patients will quit smoking, and the approach ensures all patients have access to treatment even if they aren't currently motivated to quit.

Through this study, Hollings researchers hope to prove similar benefits can be achieved for people with HIV.

Most people have to seek out options for tobacco treatment, which requires a great deal of motivation. And even still, they may encounter barriers. By optimizing the delivery of effective tobacco treatments for people living with HIV, we hope to increase the number of people receiving tobacco treatment, increase tobacco cessation rates and reduce the risk of morbidity and mortality from smoking-related causes."

Alana Rojewski, Ph.D., Hollings Cancer Control Program Researcher

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