Bavishi Poyani, Harsono Dini, Mistler Colleen, Ledgerwood David M, Bold Krysten W, Sigel Keith, Weiss June, Yager Jessica E, Bernstein Steven L, Edelman E Jennifer
Cooper Medical School of Rowan University, Camden, NJ, USA.
Yale School of Public Health, New Haven, CT, USA.
AIDS Behav. 2025 Apr;29(4):1166-1182. doi: 10.1007/s10461-024-04592-9. Epub 2025 Jan 7.
Contingency management (CM), an evidence-based behavioral strategy that rewards positive behavior change including tobacco cessation, is rarely offered to support people with HIV (PWH) who smoke. In this study, we explored perspectives among patients and research staff engaged in a multi-site randomized clinical trial involving clinical pharmacist-delivered CM within HIV clinics. Between February and September 2023, we conducted 1:1 interviews with 12 PWH randomized to receive CM and one focus group with 8 staff (i.e., clinical pharmacists and research coordinators). Qualitative data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) implementation science framework to understand barriers and facilitators related to evidence (perspectives on CM for smoking cessation), context (HIV clinics), and facilitation (promoting effectiveness and sustainability). Regarding evidence, PWH and staff had limited prior experience with CM and supported the use of exhaled carbon monoxide to promote accountability. PWH and staff thought CM was useful in bolstering internal motivation, but differed on ideal target behaviors (i.e., cessation vs. reduction). Regarding context, clinical pharmacist-delivered tobacco treatment within HIV clinics was viewed favorably, with mixed perspectives regarding optimal visit schedules and utility of remote CM. Regarding facilitation, PWH and research staff discussed strategies to increase participant engagement and retention such as incorporating behavioral counseling services. PWH endorsed application of CM beyond smoking cessation and for people without HIV. Future efforts should consider expanding the use of CM to target smoking cessation and related health behaviors and tailoring the intervention to individual needs and goals.
应急管理（CM）是一种基于证据的行为策略，旨在奖励包括戒烟在内的积极行为改变，但很少用于支持吸烟的艾滋病毒感染者（PWH）。在本研究中，我们探讨了参与一项多中心随机临床试验的患者和研究人员的观点，该试验在艾滋病毒诊所中由临床药剂师提供CM。在2023年2月至9月期间，我们对12名随机接受CM的PWH进行了一对一访谈，并与8名工作人员（即临床药剂师和研究协调员）进行了一次焦点小组讨论。定性数据的收集和分析基于卫生服务研究实施促进行动（PARIHS）实施科学框架，以了解与证据（戒烟CM的观点）、背景（艾滋病毒诊所）和促进（提高有效性和可持续性）相关的障碍和促进因素。关于证据，PWH和工作人员以前对CM的经验有限，并支持使用呼出一氧化碳来促进责任追究。PWH和工作人员认为CM有助于增强内在动力，但在理想的目标行为（即戒烟与减少吸烟）上存在分歧。关于背景，艾滋病毒诊所内由临床药剂师提供的烟草治疗受到好评，但对于最佳就诊时间表和远程CM的效用存在不同观点。关于促进，PWH和研究人员讨论了增加参与者参与度和留存率的策略，例如纳入行为咨询服务。PWH认可将CM应用于戒烟之外，并应用于非艾滋病毒感染者。未来的工作应考虑扩大CM的使用范围，以针对戒烟和相关健康行为，并根据个人需求和目标调整干预措施。
