Unhealthy alcohol use’s impact on clinical pharmacist-delivered tobacco treatment among persons with HIV: An exploratory analysis of a randomized clinical trial

AIMS: Unhealthy alcohol use (UAU) and cigarette smoking drive morbidity and mortality among persons with HIV (PWH). Few studies have focused on UAU among PWH receiving tobacco treatment. METHODS: Exploratory analysis of A SMART Approach to Treating Tobacco Use Disorder (SMARTTT) trial Stage 1 data, during which participants were randomized to clinical pharmacist-delivered nicotine replacement therapy (NRT) alone or NRT with contingency management (NRT+CM) in HIV clinics from 7/2020-3/2024. Analyses were restricted to participants with baseline AUDIT-C; UAU was defined by AUDIT-C (women=3+/men=4+). Outcomes included visit completion rates, adjusted differences in cigarettes per day (CPD) and abstinence at week 12. RESULTS: Participants (n=314) smoked a mean of 13 CPD and 27% reported UAU at baseline. Participants with UAU were more likely to be younger, Black, healthier, report using cannabis and stimulants and greater reliance on the bus or walking for transportation. Participants with UAU generally had lower visit completion rates. Treatment differences in CPD between NRT+CM and NRT alone at week 12 did not vary by UAU (least squares means UAU: 6.0 vs. 6.7 and no UAU: 6.1 vs. 5.3, respectively; difference in adjusted treatment difference [95% CI]=1.6 [-2.1, 5.3]). Treatment differences in abstinence were also not moderated by UAU (UAU: 18.9% vs. 5.5% and no UAU: 21.7% vs. 10.0%; difference in adjusted difference [95% CI]=1.7% [-14.3%, 17.8%]). CONCLUSIONS: Among SMARTTT participants, UAU was common and associated with lower visit completion, without observed effects on smoking outcomes. Future studies should focus on targeting UAU and TUD together to optimize outcomes.