Drs. E. Jennifer Edelman and Steven L. Bernstein received a grant award to address tobacco smoking addiction among people with HIV. The National Cancer Institute grant, totaling more than $3 million, supports a five-year research project.
Smoking is a major threat to the health and wellbeing of people with HIV, yet research on the effectiveness of long-term treatment solutions to this relapsing condition is scant. Bernstein and Edelman will investigate a new clinical trial approach called SMART or Sequential Multiple Assignment Randomized Trial. Using SMART, they will conduct a two-stage, randomized trial of more than 600 adults with HIV who smoke cigarettes. Trial participants will either use a combination of nicotine replacement therapies (NRT) or NRT and “contingency management,” which is the use of rewards to incentivize verifiable behavior change — in this case, tobacco abstinence confirmed with exhaled carbon monoxide testing. Participants who do not respond to the initial treatment will then receive varenicline, a partial nicotine receptor agonist that helps people stop smoking, with or without contingency management.
The study will be conducted in HIV clinics in New Haven, Manhattan, and Brooklyn. A unique aspect of the study is that the intervention will be delivered by clinical pharmacists, who are a growing part of the team in HIV clinics and have played an important role in helping expand access to smoking treatments in primary care settings.
The goals of the trial are to study the effectiveness of this dynamic treatment approach; investigate the impact of treatment on HIV; and examine the delivery of the intervention to inform future implementation efforts.
Edelman is an associate professor in General Internal Medicine and Public Health. Her research focuses on optimizing HIV prevention and treatment as it relates to substance use.
Bernstein, a professor of Emergency Medicine and Public Health, is the founding director of the Yale Center for Implementation Science. His work focuses on developing screening and treatment interventions for tobacco users in hospital settings.