# Treatment Development for Smoking Cessation and Engagement in HIV/TB Care in South Africa

> **NIH NIH R34** · MASSACHUSETTS GENERAL HOSPITAL · 2024 · $181,880

## Abstract

Overview: This proposal directly addresses one of the most critical public health challenges impacting the
health and survival of people with HIV (PWH) and/or tuberculosis (TB) in South Africa (SA): smoking.
Background/Significance: Smoking reduces antiretroviral therapy (ART) adherence among PWH,
compromising HIV treatment outcomes, and is linked to lower TB treatment adherence among patients newly
diagnosed with TB, as well as to TB treatment failure, loss to follow up during treatment, and death during or
after treatment.
Preliminary studies: In this R34 application, we propose to develop a smoking cessation intervention tailored
to the SA context that improves disease outcomes for both HIV and TB, bringing together our experience from
two overlapping areas of research. First, we completed a randomized controlled trial (RCT) that established initial
efficacy, feasibility, and acceptability of a cognitive behavioral therapy smoking cessation intervention (QUIT) for
PWH in the US, which increased biologically-verified abstinence rates at 6 months compared to controls.1
Second, we recently completed an efficacy/effectiveness trial of a cognitive behavioral ART adherence
intervention, which successfully increased HIV treatment adherence and reduced viral load among PWH in Cape
Town.2 Therefore, our US- and SA-based investigator team has expertise in smoking cessation treatment
development for individuals with chronic disease and in adapting evidence-based, cognitive behavioral strategies
for treatment adherence in a low-resource setting.
Approach: We now propose to extend this body of work by developing QUIT-AD, a novel intervention which will
integrate our QUIT program with cognitive behavioral strategies that have been culturally adapted to improve
treatment adherence among PWH and/or TB in SA. To do so, we will: more thoroughly understand (a) barriers
to smoking cessation among adults with HIV and/or TB and (b) barriers to TB treatment adherence among adults
with TB who use tobacco (Aim 1); adapt the QUIT protocol, adding and removing content as appropriate based
on the formative data, and conduct a small proof-of-concept open trial (n = 5; Aim 2); and assess the feasibility
and acceptability of the intervention in a pilot RCT to be task shifted to lay counselors (Aim 3). Secondary
outcomes of the RCT will be biologically-verified point prevalence tobacco abstinence, number of cigarettes
smoked in the past week, and favorable HIV/TB treatment outcome at 6 months.
Outcomes/next steps: These aims will lay the groundwork for a full-scale, hybrid effectiveness/implementation
trial which could change the smoking cessation treatment landscape in SA, provide an empirically supported
program for PWH and/or TB, and serve as a model for future work to sustain smoking abstinence among
individuals with chronic diseases in resource-limited settings.

## Key facts

- **NIH application ID:** 10895387
- **Project number:** 5R34DA057169-02
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Conall Michael O'Cleirigh
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $181,880
- **Award type:** 5
- **Project period:** 2023-08-01 → 2026-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10895387

## Citation

> US National Institutes of Health, RePORTER application 10895387, Treatment Development for Smoking Cessation and Engagement in HIV/TB Care in South Africa (5R34DA057169-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10895387. Licensed CC0.

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