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Clinical Pharmacist-Led Smoking Reduction in HIV Clinics: Study Results

Publication Title: Clinical Pharmacists, Medications, and Contingency Management for Targeting Smoking in HIV Clinics

Summary

Question

This study examined the effectiveness of clinical pharmacist-led treatments, including nicotine replacement therapy (NRT), oral medications for tobacco use disorder, and contingency management (CM), for reducing cigarette smoking among people with HIV. The researchers sought to determine the best strategies for reducing cigarette consumption and achieving smoking abstinence using adaptive treatment approaches.

Why it Matters
Cigarette smoking is a major health concern for people with HIV, leading to higher risks of illness and death than HIV itself. Smoking cessation improves health outcomes, but people with HIV face unique challenges in quitting. This research is significant because it explores practical, scalable methods to address smoking among this population, potentially improving their quality of life and reducing health disparities. The findings provide HIV clinics with actionable strategies to integrate smoking cessation into patient care.
Methods
The researchers conducted a sequential multiple-assignment randomized trial (SMART) at HIV clinics in the U.S. Participants (323 adults with HIV who smoked) were initially randomized to receive NRT alone or NRT combined with CM, where participants earned rewards for verified smoking abstinence. After 12 weeks, those who were still smoking were re-randomized to either switch to oral medications (varenicline or bupropion) or receive intensified CM. Treatments were delivered by clinical pharmacists over 24 weeks.
Key Findings
At 12 weeks, both NRT alone and NRT with CM reduced daily cigarette consumption, but abstinence rates were higher in the NRT plus CM group (22.5%) compared to NRT alone (9.8%). Among participants who did not quit smoking by week 12, adding CM to NRT resulted in greater reductions in cigarette use compared to switching to oral medications, particularly for those who initially received NRT alone. By 24 weeks, the most effective strategy for reducing cigarette consumption involved starting with NRT and adding CM if needed, while the best strategy for achieving abstinence was starting with NRT plus CM and intensifying CM if necessary.
Implications
The findings suggest that CM, which provides tangible rewards for verified abstinence, is a valuable addition to NRT for improving smoking outcomes among people with HIV. Clinical pharmacists can play a key role in delivering these interventions within HIV clinics. This research supports the integration of CM into tobacco use disorder treatment in HIV care settings, potentially improving patient outcomes and addressing health inequities.
Next Steps

The authors recommend further research to optimize CM programs, explore factors that impact the effectiveness of oral medications (e.g., adherence), and examine how interventions are delivered. They also highlight the need for sustainable models that integrate CM into routine HIV care, ensuring broader access to effective smoking cessation strategies.

Funding Information
This research was supported by the National Cancer Institute (grant R01CA243910) and the National Institute on Drug Abuse (grants T32DA019426 and additional support reported by Dr. Nahum-Shani). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Yale University also provided funding and support for this research.

Full Citation

Edelman E, Deng Y, Dziura J, Nahum-Shani I, Weiss J, Aoun-Barakat L, Bold K, Harsono D, Mistler C, Payne E, Aiudi S, Sigel K, Yager J, Ledgerwood D, Bernstein S. Clinical Pharmacists, Medications, and Contingency Management for Targeting Smoking in HIV Clinics. JAMA Network Open 2026, 9: e2560593. PMID: 41758512, PMCID: PMC12949440, DOI: 10.1001/jamanetworkopen.2025.60593.
This AI-assisted summary has been reviewed and approved by at least one of the study's authors to ensure it accurately reflects the research.

Authors

  • E. Jennifer Edelman, MD, MHS, AAHIVS

    First Author
    Yale School of Medicine

    Professor of Medicine (General Medicine)

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  • Steven L. Bernstein

    Last Author
    School Building Streamline Icon: https://streamlinehq.comOther Institution

Additional Yale School of Medicine Authors

Other Authors

  • Inbal Nahum-Shani;
  • Colleen Mistler;
  • Erika Payne;
  • Sherry Aiudi;
  • Keith M. Sigel;
  • Jessica E. Yager;
  • David M. Ledgerwood

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Keywords

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