# Population reach, feasibility and acceptability of digital therapeutics for smoking cessation among people living with HIV: Results of the Quitting Matters pilot trial

## TL;DR

A digital smoking cessation tool tailored for people living with HIV showed higher engagement and promising outcomes compared to a standard tool in a pilot trial.

## Contribution

The study introduces and evaluates a novel digital therapeutic (LTQ-H) tailored for people living with HIV.

## Key findings

- LTQ-H users had significantly more device interactions and engagement with smoking cessation content compared to QuitGuide users.
- Despite higher baseline challenges (e.g., cannabis use), LTQ-H showed numerically better cessation outcomes at week 12.
- The study suggests LTQ-H has potential for population reach and engagement in smoking cessation for people with HIV.

## Abstract

Tobacco use is disproportionately prevalent among people living with
HIV (PWH) and is a significant contributor to morbidity and mortality in
this population. Reaching communities of PWH to facilitate smoking cessation
is challenging. Digital Therapeutics (DTx) can facilitate widespread
implementation and adoption of smoking cessation treatments for PWH.

We compared the feasibility and acceptability (primary outcomes) and
preliminary efficacy (secondary outcome) of a DTx tailored to PWH –
Learn to Quit-HIV (LTQ-H) – versus a gold standard
smoking cessation DTx (QuitGuide) in a remote pilot randomized controlled
trial. All participants received nicotine replacement therapy and were
assessed at weeks 4, 8, and 12.

During a 13-month period, we remotely recruited a sample of PWH (n =
41) across the United States, with randomization leading to a higher
proportion of LTQ-H users with high levels of cannabis use.
Digital markers of DTx use indicated that compared to QuitGuide, assignment
to LTQ-H led to significantly greater number of device
interactions (3610 vs 2086; RR=93.14; 95 % CI: 14.70–590; p <
0.001), and a four-fold increase in mean interactions with active smoking
cessation content (8.5 vs. 2.15; Cohen’s d=0.91; p < 0.001).
At week 12, in an adjusted model, LTQ-H resulted in
numerically greater, but not statistically significant, biochemically
verified 7-day point prevalence abstinence versus QuitGuide (18.2 % vs 15.8
%; aOR=6.97, 95 % CI: 0.65–74.33).

While participants assigned to LTQ-H had
proportionally more features known to predict low quit rates (e.g. cannabis
use), LTQ-H showed promising population reach, device
engagement, and smoking outcomes. A hybrid effectiveness-implementation
trial will evaluate this novel DTx in a larger sample of PWH.

The study highlights the potential of DTx to address the high
prevalence of tobacco use among people with HIV. Compared to QuitGuide (gold
standard DTx developed by NCI), LTQ-H showed promising
participant engagement and smoking cessation outcomes. These findings
suggest that LTQ-H could be a valuable tool for smoking
cessation in people with HIV, warranting further investigation in larger
trials to evaluate its effectiveness and implementation feasibility.