- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04490057
A Smart Approach to Treating Tobacco Use Disorder in Persons Living With HIV (SMARTTT)
April 17, 2024 updated by: Yale University
Many people living with HIV (PLWH) smoke.
Smoking in these individuals is often undertreated.
This study plans to assess the ability of various clinical pathways involving tobacco treatment medications and contingency management (paying smokers for not smoking) to improve smoking cessation in a group of PLWH.
Study Overview
Status
Active, not recruiting
Conditions
Detailed Description
Using a Sequential Multiple Assignment Randomized Trial (SMART) design, this project is a two-arm, two-stage randomized trial of 320 adult PWH who smoke cigarettes and receive care in one of three health systems (targeted enrollment changed from 632 to 320 with NCI approval and IRB protocol amendment).
At inception, participants will be randomized to either combination nicotine replacement therapy (NRT, patch + short-acting NRT) or combination NRT+contingency management (CM).
At 12 weeks, responders (non-smoking participants confirmed by exhaled carbon monoxide [eCO] or collateral verification) in both arms will receive 12 more weeks of the same treatment.
Non-responders (participants with continued smoking by self-report and/or eCO) in both the NRT and NRT+CM arms will be re-randomized to 12 weeks of treatment, either with medication switch to oral medication, varenicline or bupropion, or intensified level of CM (start CM if no CM during first 12 weeks, or CM with higher reward schedule ["CM plus"] if NRT+CM group initially).
The intervention will be delivered by trained clinical pharmacists.
The primary outcome will be self-reported abstinence at 24 weeks post-enrollment (primary outcome changed from eCO-confirmed abstinence to self-reported abstinence with NCI approval and IRB protocol amendment).
The specific aims of the proposed study are to: (1) identify the optimal adaptive approach to promote reduced tobacco use (changed from eCO-confirmed smoking abstinence with NCI approval and protocol amendment) (2) study the effectiveness of various adaptive strategies on CD4 count, HIV viral suppression, and VACS index (validated measure of morbidity and mortality risk); and (3) grounded in implementation science and using aHybrid Effectiveness-Implementation Type I design, identify barriers and facilitators to delivering our intervention to inform future implementation.
Study Type
Interventional
Enrollment (Estimated)
320
Phase
- Phase 4
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: June-Marie Weiss, MA, MEd
- Phone Number: 203-737-3347
- Email: junemarie.weiss@yale.edu
Study Locations
-
-
Connecticut
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Bridgeport, Connecticut, United States, 06110
- Bridgeport Hospital Infectious Disease Clinic
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New Haven, Connecticut, United States, 06510
- Yale University School of Medicine
-
-
New York
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Brooklyn, New York, United States, 11203
- SUNY Downstate STAR Clinic
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New York, New York, United States, 10029
- Icahn School of Medicine at Mount Sinai
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- HIV positive;
- >= 18 years old
- Receiving HIV care at Yale-New Haven Hospital, Bridgeport Hospital, Mount Sinai Hospital, or SUNY Downstate STAR clinic;
- Have smoked >= 100 cigarettes in lifetime;
- Currently smokes some days or every day;
- Smokes, on average, >= 5 cigarettes per day;
- Able to provide written informed consent.
Exclusion Criteria:
- Using only non-cigarette nicotine products (i.e., e-cigs, Juul, etc.);
- Currently using NRT, VAR, or bupropion (defined as use in the prior 7 days);
- Self-report or urine testing confirming pregnancy, nursing, or trying to conceive;
- Life-threatening or unstable medical, surgical, or psychiatric condition;
- Inability to provide at least one collateral contact (family member or friend);
- Living out of state;
- Unable to read or understand English (except at Mount Sinai site).
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Sequential Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: 12 wks NRT+CM / 12 wks NRT+CM
Nicotine replacement therapy combined with contingency management.
Responders remain on same treatment for second 12 weeks.
|
Participants will be prescribed both long-acting and short-acting nicotine replacement therapy.
Participants will be financially rewarded for abstinence to tobacco.
|
Experimental: 12 wks NRT+CM/ 12 wks VAR or bupropion+CM
Nicotine replacement therapy combined with contingency management.
Non-responders switch to varenicline or bupropion combined with contingency management for second 12 weeks.
|
Participants will be prescribed both long-acting and short-acting nicotine replacement therapy.
Participants will be prescribed varenicline (Chantix) or bupropion (Wellbutrin).
Participants will be financially rewarded for abstinence to tobacco.
|
Experimental: 12 wks NRT+CM/12 wks NRT+CM plus
Nicotine replacement therapy combined with contingency management Non-responders switch to nicotine replacement therapy combined with intensified contingency management for second 12 weeks.
|
Participants will be prescribed both long-acting and short-acting nicotine replacement therapy.
Participants will be financially rewarded for abstinence to tobacco.
|
Experimental: 12 wks NRT/ 12 wks NRT
Nicotine replacement therapy alone.
Responders remain on nicotine replacement therapy.
|
Participants will be prescribed both long-acting and short-acting nicotine replacement therapy.
|
Experimental: 12 wks NRT/ 12 wks VAR or bupropion
Nicotine replacement therapy alone.
Non-responders switch to varenicline or bupropion alone for second 12 weeks.
|
Participants will be prescribed both long-acting and short-acting nicotine replacement therapy.
Participants will be prescribed varenicline (Chantix) or bupropion (Wellbutrin).
|
Experimental: 12 wks NRT/ 12 wks NRT+CM
Nicotine replacement therapy alone.
Non-responders switch to nicotine replacement therapy combined with contingency management for second 12 weeks.
|
Participants will be prescribed both long-acting and short-acting nicotine replacement therapy.
Participants will be financially rewarded for abstinence to tobacco.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Self reported reduction in average cigarettes smoked per day at 24 weeks
Time Frame: 24 weeks from baseline
|
Self reported reduction in average cigarettes smoked per day
|
24 weeks from baseline
|
Self reported reduction in average cigarettes smoked per day at 12 weeks
Time Frame: 12 weeks from baseline
|
Self reported reduction in average cigarettes smoked per day
|
12 weeks from baseline
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
VACS index 2.0
Time Frame: 24 weeks from baseline
|
A validated measure of morbidity and mortality
|
24 weeks from baseline
|
CD4 Count
Time Frame: 24 weeks from baseline
|
Median CD4 count adjusting for baseline
|
24 weeks from baseline
|
HIV Viral Load
Time Frame: 24 weeks from baseline
|
The proportion of participants with HIV viral load suppression.
|
24 weeks from baseline
|
eCO confirmed smoking abstinence at 24 weeks
Time Frame: 24 weeks from baseline
|
smoking abstinence confirmed by exhaled carbon monoxide
|
24 weeks from baseline
|
eCO confirmed smoking abstinence at 12 weeks
Time Frame: 12 weeks from baseline
|
smoking abstinence confirmed by exhaled carbon monoxide
|
12 weeks from baseline
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Identification of Barriers and Facilitators
Time Frame: Baseline and Up to 4 years
|
Using a Hybrid Effectiveness-Implementation Type I design, identify barriers and facilitators to delivering our intervention to inform future implementation.
|
Baseline and Up to 4 years
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Steven Bernstein, MD, Dartmouth College
- Principal Investigator: E. Jennifer Edelman, MD, MHS, Yale University
Publications and helpful links
The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
July 27, 2020
Primary Completion (Estimated)
November 30, 2024
Study Completion (Estimated)
September 30, 2025
Study Registration Dates
First Submitted
July 22, 2020
First Submitted That Met QC Criteria
July 25, 2020
First Posted (Actual)
July 28, 2020
Study Record Updates
Last Update Posted (Actual)
April 19, 2024
Last Update Submitted That Met QC Criteria
April 17, 2024
Last Verified
April 1, 2024
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Mental Disorders
- Chemically-Induced Disorders
- Substance-Related Disorders
- Tobacco Use Disorder
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Autonomic Agents
- Peripheral Nervous System Agents
- Cholinergic Agents
- Enzyme Inhibitors
- Psychotropic Drugs
- Neurotransmitter Uptake Inhibitors
- Membrane Transport Modulators
- Antidepressive Agents
- Dopamine Agents
- Cytochrome P-450 Enzyme Inhibitors
- Ganglionic Stimulants
- Nicotinic Agonists
- Cholinergic Agonists
- Antidepressive Agents, Second-Generation
- Cytochrome P-450 CYP2D6 Inhibitors
- Dopamine Uptake Inhibitors
- Nicotine
- Bupropion
- Varenicline
Other Study ID Numbers
- 2000026332
- R01CA243910 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
NO
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Yes
Studies a U.S. FDA-regulated device product
No
product manufactured in and exported from the U.S.
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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