PRIMARY OBJECTIVES:
I. Evaluate the effects of ENHANCE-TTS, an evidence-based Tobacco Treatment Specialist training with clinical tools and facilitation support, on pharmacists’ tobacco treatment care delivery adoption (tobacco use disorder diagnosis codes entered, tobacco treatment pharmacotherapy prescriptions written [e.g., varenicline]; tobacco treatment counseling codes entered) in 6 Ryan White HIV care settings. (Implementation)
II. Evaluate implementation outcomes across diverse Ryan White care settings at patient, provider, and organizational levels. (Implementation)
III. Evaluate the effects of TTS training and clinic facilitation support on patient-level tobacco treatment outcomes among PLWH. (Effectiveness)
OUTLINE: HIV care clinics are randomized to 1 of 6 sequences and patients are assigned to the sequence to which their clinic was randomized.
SEQUENCE 1:
PRE-INTERVENTION: Clinics engage in usual care practices and undergo data collection on tobacco treatment care delivery over 6 months (months 1-6).
INTERVENTION: Clinics receive ENHANCE-TTS consisting of team building, pharmacist training, infrastructure planning for systems change, problem-solving, coaching, clinic roadmaps, a readiness assessment, and training workbooks for 3 months (months 7-9).
POST-INTERVENTION: Clinics receive monthly check-in calls for 3 months and undergo monitoring for a total of 42 months (months 10-51). Patients who receive tobacco counseling in the post-TTS period undergo carbon monoxide breath sample collection at 3 and 6 months post-tobacco counseling.
SEQUENCE 2:
PRE-INTERVENTION: Clinics engage in usual care practices and undergo data collection on tobacco treatment care delivery over 12 months (months 1-12).
INTERVENTION: Clinics receive ENHANCE-TTS consisting of team building, pharmacist training, infrastructure planning for systems change, problem-solving, coaching, clinic roadmaps, a readiness assessment, and training workbooks for 3 months (months 13-15).
POST-INTERVENTION: Clinics receive monthly check-in calls for 3 months and undergo monitoring for a total of 36 months (months 16-51). Patients who receive tobacco counseling in the post-TTS period undergo carbon monoxide breath sample collection at 3 and 6 months post-tobacco counseling.
SEQUENCE 3:
PRE-INTERVENTION: Clinics engage in usual care practices and undergo data collection on tobacco treatment care delivery over 18 months (months 1-18).
INTERVENTION: Clinics receive ENHANCE-TTS consisting of team building, pharmacist training, infrastructure planning for systems change, problem-solving, coaching, clinic roadmaps, a readiness assessment, and training workbooks for 3 months (months 19-21).
POST-INTERVENTION: Clinics receive monthly check-in calls for 3 months and undergo monitoring for a total of 30 months (months 22-51). Patients who receive tobacco counseling in the post-TTS period undergo carbon monoxide breath sample collection at 3 and 6 months post-tobacco counseling.
SEQUENCE 4:
PRE-INTERVENTION: Clinics engage in usual care practices and undergo data collection on tobacco treatment care delivery over 24 months (months 1-24).
INTERVENTION: Clinics receive ENHANCE-TTS consisting of team building, pharmacist training, infrastructure planning for systems change, problem-solving, coaching, clinic roadmaps, a readiness assessment, and training workbooks for 3 months (months 25-27).
POST-INTERVENTION: Clinics receive monthly check-in calls for 3 months and undergo monitoring for a total of 24 months (months 28-51). Patients who receive tobacco counseling in the post-TTS period undergo carbon monoxide breath sample collection at 3 and 6 months post-tobacco counseling.
SEQUENCE 5:
PRE-INTERVENTION: Clinics engage in usual care practices and undergo data collection on tobacco treatment care delivery over 30 months (months 1-30).
INTERVENTION: Clinics receive ENHANCE-TTS consisting of team building, pharmacist training, infrastructure planning for systems change, problem-solving, coaching, clinic roadmaps, a readiness assessment, and training workbooks for 3 months (months 31-33).
POST-INTERVENTION: Clinics receive monthly check-in calls for 3 months and undergo monitoring for a total of 18 months (months 34-51). Patients who receive tobacco counseling in the post-TTS period undergo carbon monoxide breath sample collection at 3 and 6 months post-tobacco counseling.
SEQUENCE 6:
PRE-INTERVENTION: Clinics engage in usual care practices and undergo data collection on tobacco treatment care delivery over 36 months (months 1-36).
INTERVENTION: Clinics receive ENHANCE-TTS consisting of team building, pharmacist training, infrastructure planning for systems change, problem-solving, coaching, clinic roadmaps, a readiness assessment, and training workbooks for 3 months (months 37-39).
POST-INTERVENTION: Clinics receive monthly check-in calls for 3 months and undergo monitoring for a total of 12 months (months 40-51). Patients who receive tobacco counseling in the post-TTS period undergo carbon monoxide breath sample collection at 3 and 6 months post-tobacco counseling.
