Rewards program makes quitting smoking easier for people with HIV

People with HIV may be more successful in quitting smoking when they use a rewards-based program along with nicotine replacement therapy (NRT), like nicotine patches, instead of just taking medications like varenicline and bupropion, according to recent clinical trial results published in Substance Use and Addiction.

A team of researchers led by E. Jennifer Edelman, M.D., M.H.S., professor of general medicine at Yale School of Medicine, enrolled 323 HIV-positive participants, who smoked an average of 13 cigarettes a day.

Cigarette abstinence for at least seven days was confirmed with an exhaled carbon monoxide level of 6 ppm or less, or it was verified by a close informant.

For the first stage, contingency management (CM) rewards included fishbowl draws and gift cards to local stores or reloadable debit cards with maximum earnings of $350 and $850 for stage two. Participants earned additional draw opportunities that increased in response to prolonged abstinence.

Edelman and her team tested different strategies to help people quit smoking over two stages of treatment. Participants met with residency-trained clinical pharmacists in HIV clinics during 10 visits across 24 weeks. After the first 12 weeks, participants who used NRT, along with CM, had higher quit rates (23%) than those using NRT alone (10%).

For participants who did not quit during the first stage, researchers either intensified the rewards program or switched them to a different medication. By week 24, those who received a stronger rewards program smoked fewer cigarettes per day than those who switched medications, particularly among participants who initially started with NRT alone.

Overall, the lowest number of cigarettes smoked per day at 24 weeks was observed among participants who began with NRT alone and later added the rewards program. While the highest abstinence rate at 24 weeks occurred in the group that used NRT plus the rewards program throughout the study, the difference compared with other approaches was not statistically significant.

As HIV treatments have improved, patients are living longer, but as they age, they face other deadly challenges, like tobacco use disorder, which is a major driver of comorbidity and mortality in this population.

In fact, smoking may be deadlier than treated HIV, and people with HIV who smoke are less likely to quit than the general population.

Despite being such a major issue, there is a lack of strategies to reduce cigarette smoking in this population, Edelman and her team explain in the study.

“Given the overall low levels of cigarettes per day smoked and high rates of abstinence achieved during the intervention period, our findings yielded support for clinical pharmacist–delivered tobacco use disorder treatment involving contingency management integrated into HIV clinics,” Edelman said in the study. “Future studies should focus on tailoring tobacco treatment interventions in HIV settings by considering adverse social determinants of health, identifying treatment goals (e.g., abstinence vs. reduction), providing more flexible reward programs, including other verifiable targets to address tobacco use disorder and facilitating enhanced patient choice regarding medications for tobacco use disorder to engage people with HIV quickly and consistently.”