{"doi":"10.1093/ntr/ntaf077","title":"A Proof-of-Concept Feasibility Trial Testing a Multi-Component App-Based Intervention for Improving Smoking Cessation and Adherence to Treatment in Low-Income HIV Patients","abstract":"INTRODUCTION: Low-income people living with HIV (PLWH) in the United States encounter several behavioral challenges. Multiple-behavior interventions targeting multiple risks are promising. Cigarette smoking remains high among PLWH (47%), and smokers have low adherence to antiretroviral therapy (ART). This study explores the feasibility of a smartphone app-based intervention combining mindfulness training (MT) for smoking cessation with video directly observed therapy (vDOT) for ART monitoring among minority and low-income PLWH. METHODS: We conducted a proof-of-concept feasibility three-arm randomized controlled trial among PLWH (n = 39; 53.8% males) to test three treatment groups (Gs): (G1) usual care (UC; brief advice to quit and ART adherence); (G2) MT app plus brief advice to ART adherence; and (G3) MT plus vDOT apps. The primary outcomes were intervention feasibility, acceptability, app usability, smoking cessation, and ART adherence improvement. RESULTS: Enrollment rate was low (37%) due to low access to technology and language barriers. Retention rates were high (UC: 92.3%, G2: 84.6%, G3: 100.0%). The MT app usability was higher (G2: 72.8%, G3: 69.2%) than the vDOT app (G3: 23.1%). G2 participants were more satisfied with treatment than G3 (p < .04). Smoking abstinence rates in G2 and G3 were double that in UC (UC: 25.0%, G2: 45.5%, G3: 53.8%). ART adherence improved by 53.0% in G2 and G3 compared to 30.7% in UC. CONCLUSIONS: The combined intervention was promising. However, the app-based intervention feasibility was low, and vDOT for ART monitoring was unacceptable. These results will inform the optimization and further testing of the multi-component intervention. IMPLICATIONS: Disparities in HIV persist among minority and low-income groups who face several behavioral challenges. The current proof-of-concept trial indicated that the multiple-behavior intervention targeting smoking cessation and adherence to ART in minority and low-income PLWH is promising. However, given the low access to technology and the language barrier in this group, the feasibility of the app-based intervention was low. Video-based strategy to monitor ART adherence was not acceptable due to privacy concerns. As healthcare becomes more reliant on technology-based tools, research is needed to address the digital divide among this group to prevent the exacerbation of existing healthcare access disparities.","journal":"Nicotine & Tobacco Research","year":2025,"id":543613,"datarank":0.16479184330021646,"base_score":1.0986122886681096,"endowment":1.0986122886681096,"self_citation_contribution":0.16479184330021646,"citation_network_contribution":0.0,"self_endowment_contribution":0.16479184330021646,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9488,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":336205,"name":"David Lee","orcid":"0000-0002-7536-9692","position":1,"is_corresponding":false},{"id":409544,"name":"María L. Alcaide","orcid":"0000-0003-4648-0145","position":2,"is_corresponding":false},{"id":391094,"name":"Deborah L. Jones","orcid":"0000-0002-4106-8891","position":3,"is_corresponding":false},{"id":376013,"name":"Michael J. Zvolensky","orcid":"0000-0002-1869-0906","position":4,"is_corresponding":false},{"id":883665,"name":"Olusanya Joshua Oluwole","orcid":"0000-0002-1488-3997","position":5,"is_corresponding":false},{"id":521938,"name":"Yue Pan","orcid":"0000-0001-9586-0975","position":6,"is_corresponding":false},{"id":409923,"name":"Judson A. Brewer","orcid":"0000-0001-8984-6704","position":7,"is_corresponding":false},{"id":426536,"name":"Adam W. Carrico","orcid":"0000-0002-8146-5701","position":8,"is_corresponding":false},{"id":651731,"name":"Taghrid Asfar","orcid":"0000-0003-1133-9723","position":0,"is_corresponding":true}],"reference_count":43,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T02:53:04.088079Z","pmid":"40178164","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}