# Optimizing Tobacco Treatment Delivery for People Living with HIV

> **NIH NIH R01** · MEDICAL UNIVERSITY OF SOUTH CAROLINA · 2024 · $19,748

## Abstract

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 tr...

## Key facts

- **NIH application ID:** 10977403
- **Project number:** 3R01CA261232-04S1
- **Recipient organization:** MEDICAL UNIVERSITY OF SOUTH CAROLINA
- **Principal Investigator:** Alana Rojewski
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $19,748
- **Award type:** 3
- **Project period:** 2021-03-15 → 2026-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10977403

## Citation

> US National Institutes of Health, RePORTER application 10977403, Optimizing Tobacco Treatment Delivery for People Living with HIV (3R01CA261232-04S1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10977403. Licensed CC0.

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