Targeting smoking with clinical pharmacist-delivered medications and contingency management in HIV clinics: Findings from a SMART
E. Jennifer Edelman

We lack robust strategies to reduce cigarette smoking among people with HIV (PWH). In this sequential multiple assignment randomized trial (SMART), we sought to identify the optimal adaptive strategy involving clinical pharmacist-delivered medications for tobacco use disorder (MTUD) and contingency management (i.e., use of prizes for confirmed abstinence) smoking reduction among PWH. In Stage 1, participants were randomized 1:1 to dual nicotine replacement therapy +/- contingency management. After 12 weeks (Stage 2), individuals with confirmed abstinence continued Stage 1 treatment; those without confirmed abstinence were re-randomized to “switch” medications from NRT to oral MTUD (varenicline or bupropion) or “intensify” contingency management. Interventions were delivered by clinical pharmacists in HIV clinics over 24 weeks. Based on data on 323 enrolled participants, we found that contingency management is an effective adjunct to clinical pharmacist-delivered NRT for improving tobacco-related outcomes; however, the optimal timing to add contingency management differs based on tobacco-related treatment goals.