Tobacco Treatment Specialist Training for Clinical Pharmacists to Advance Service Delivery for People Living with HIV

PROJECT SUMMARY Smoking rates among people living with HIV (PLWH) are approximately 40-50%, over triple the rate in the general United States population. The health effects of smoking on PLWH are significant, with PLWH losing more years of life to smoking than to HIV-related morbidities. Because smoking is often not addressed in the context of HIV care, few PLWH are offered evidence-based cessation treatment. Pharmacists are in a unique position to offer tobacco treatment to PLWH as many clinics funded by the federal Ryan White HIV/AIDS Program have a pharmacist on staff. As such, capitalizing on pharmacists’ roles in a comprehensive approach to HIV care, their scope of practice could be expanded to offer tobacco treatment counseling and pharmacotherapy. The ENHANCE-TTS (ENgaging pHarmacists to AdvANCE Tobacco Treatment Service delivery) program seeks to increase tobacco treatment counseling in HIV care settings through a novel program with tools, training, and facilitation support for systems change. Clinical pharmacists will be trained as Tobacco Treatment Specialists and the training will follow with technical assistance and coaching to support the implementation of new practices. This hybrid type II effectiveness-implementation study will use a stepped wedge design in 6 clinics in South Carolina. We will evaluate the effects of ENHANCE-TTS on pharmacists’ tobacco treatment care delivery adoption (pharmacotherapy prescriptions, tobacco treatment counseling codes) (Aim 1) and evaluate the acceptability, feasibility, fidelity, implementation cost, and penetration of the approach (Aim 2). Aims 1 and 2 will also characterize barriers and facilitators to implementation outcomes guided by the Consolidated Framework for Implementation Research (CFIR). Finally, in Aim 3, we will evaluate the effects of ENHANCE-TTS on patient- level tobacco treatment outcomes among PLWH using biochemically-confirmed 7-day point prevalence abstinence outcomes at 3- and 6- months following the initial counseling appointment in a subsample of patients (N=156) who received tobacco treatment from the clinical pharmacists. This study will examine a novel program with tools, training, and facilitation support for systems change within HIV care settings to deliver tobacco treatment to PLWH. Integrating effectiveness and implementation results will help define best practices for pharmacist training and engaging clinic teams for practice change to ultimately provide high-quality evidence- based tobacco treatment interventions to PLWH.