Ledgerwood David M, Lundahl Leslie H, Greenwald Mark K, Cohn Jonathan, Arfken Cynthia L
Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
Division of Infectious Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, USA.
Nicotine Tob Res. 2025 Apr 22;27(5):893-902. doi: 10.1093/ntr/ntae243.
Contingency management (CM) is an incentive-based approach that has demonstrated efficacy for smoking cessation in various populations. There is an unmet need for feasible and effective smoking cessation interventions in people with HIV (PWH). The purpose of this study was to assess the efficacy of prize-based CM for smoking cessation in PWH using a Sequential Multiple Assignment Randomization Trial (SMART) design selected to tailor intervention intensity based on early treatment response.
During phase I, 129 participants were randomly assigned to high-magnitude prize CM (HM-CM) or standard of care (SoC) for 4 weeks. Participants who did not reduce smoking were randomized in phase II to continued counseling with HM-CM plus monitoring support or only continued monitoring support for 8 weeks. Participants who reduced smoking were randomized to booster monitoring with low-magnitude CM or no additional care. Outcomes were biochemically verified smoking reduction and 7-day abstinence prevalence at posttreatment, 6-month, and 12-month follow-up.
Phase I responders (based on biochemical indicators of smoking reduction) were significantly less likely to return to smoking (during treatment and at 6 and 12 months) if they received low-magnitude incentives. Notably, initial exposure to CM versus SoC did not increase the rate of phase I response, and high-magnitude incentives later in treatment did not lead to greater smoking cessation for early-treatment nonresponders.
Weekly CM sessions in the first 4 weeks of smoking cessation intervention did not perform significantly better than SoC. However, brief booster CM sessions aimed at maintaining early smoking cessation hold clinical promise and warrant further investigation.
This represents the first trial to examine the use of CM for smoking cessation among PWH within the context of a SMART design. Clinical Trial Registration: NCT01965405 (https://clinicaltrials.gov/study/NCT01965405).
应急管理（CM）是一种基于激励的方法，已在不同人群中证明对戒烟有效。艾滋病毒感染者（PWH）对可行且有效的戒烟干预措施存在未满足的需求。本研究的目的是使用序贯多重分配随机试验（SMART）设计评估基于奖励的CM对PWH戒烟的疗效，该设计旨在根据早期治疗反应调整干预强度。
在第一阶段，129名参与者被随机分配到高剂量奖励CM（HM-CM）组或标准护理（SoC）组，为期4周。未减少吸烟的参与者在第二阶段被随机分配到继续接受HM-CM咨询加监测支持组或仅继续接受监测支持组，为期8周。减少吸烟的参与者被随机分配到接受低剂量CM强化监测组或不接受额外护理组。结局指标为治疗后、6个月和12个月随访时经生化验证的吸烟减少情况和7天戒烟率。
第一阶段有反应者（基于吸烟减少的生化指标）如果接受低剂量激励，在治疗期间以及6个月和12个月时复吸的可能性显著降低。值得注意的是，最初接触CM与SoC相比，并未提高第一阶段的反应率，且治疗后期的高剂量激励并未使早期治疗无反应者实现更大程度的戒烟。
戒烟干预前4周的每周CM疗程并不比SoC显著更有效。然而，旨在维持早期戒烟的简短强化CM疗程具有临床前景，值得进一步研究。
这是第一项在SMART设计背景下研究CM用于PWH戒烟的试验。临床试验注册：NCT01965405（https://clinicaltrials.gov/study/NCT01965405）。
