Dr. Alana Rojewski, a recognized authority in tobacco cessation therapeutics, joins forces with Dr. Katherine Sterba, an implementation scientist who specializes in embedding evidence-based clinical practices into healthcare workflows. Together, they have developed ENHANCE-TTS (ENgaging pHarmacists to AdvANCE Tobacco Treatment Service), a tailored program that aims to enhance access to and the quality of smoking cessation interventions for people living with HIV. Central to this approach is empowering pharmacists at federally funded Ryan White clinics across South Carolina—facilities specifically serving uninsured or underinsured HIV-positive patients—to become proficient tobacco cessation specialists.

The impetus for this program is rooted in the disproportionately high prevalence of smoking-related morbidities among individuals with HIV. Research underscores that tobacco use exacerbates an array of comorbidities common in this group, including cardiovascular disease and pulmonary complications, while also dramatically increasing the incidence of tobacco-related cancers. By equipping pharmacists with advanced skills in tobacco cessation, the ENHANCE-TTS initiative seeks to integrate comprehensive tobacco treatment into the routine care of people with HIV, thereby addressing a critical public health need.

The training modules designed for this program leverage existing resources from Hollings Cancer Center’s Cancer Research Education and Training branch, augmenting them with specialized content co-developed by clinical pharmacy experts. Pharmacists are taught to perform meticulous tobacco use assessments, develop individualized cessation plans, and deliver behavioral counseling aligned with the latest clinical guidelines. Emphasis is placed on intervention strategies that address pharmacologic therapies alongside behavioral techniques that help patients navigate cravings, stressors, and relapse triggers in real-world contexts.

Moreover, Dr. Emily Ware, a clinical pharmacy specialist engaged as a co-investigator, has contributed expertise toward developing a bespoke training module geared specifically for clinical pharmacists. This module comprehensively covers operational aspects such as establishing clinical practice agreements and optimizing scheduling workflows to facilitate efficient and effective tobacco cessation service delivery within diverse clinical settings. This pragmatic component ensures that pharmacists can sustainably implement their newfound skills within the logistical realities of their respective clinics.

A pivotal element of the ENHANCE-TTS program is its adaptable design that acknowledges the heterogeneity of the participating Ryan White clinics. Recognizing that a universal, one-size-fits-all model is insufficient, the researchers collaborate closely with each clinic to tailor tobacco cessation protocols that reflect the clinic’s unique patient demographics, resource availability, and operational processes. This customization enhances both acceptance and feasibility, fostering an environment conducive to lasting implementation and improved patient outcomes.

The study’s evaluation framework is robust, focusing on three primary outcome domains. Firstly, investigators will quantify the extent to which HIV care providers increase tobacco use screening and cessation counseling once their clinic pharmacists have been trained as tobacco treatment specialists. This explores whether pharmacist training has a spill-over effect on enhancing provider engagement in tobacco cessation efforts. Secondly, qualitative assessments of patient, provider, and administrator perceptions will elucidate the program’s acceptability, usability, and fidelity to the intended intervention model. Lastly, prospective follow-up with a patient cohort receiving pharmacist-led tobacco treatment seeks to quantify the impact on quit rates and sustained abstinence, providing empirical evidence of clinical effectiveness.

The project’s potential implications are substantial. Successful training and integration of pharmacists as tobacco cessation specialists could radically expand the availability of high-quality tobacco treatment services for people living with HIV, a subgroup currently underserved in this regard. The intervention holds promise for mitigating the disproportionate burden of tobacco-related disease and mortality in this population, aligning with precision public health objectives that tailor interventions to specific community needs.

Dr. Rojewski expressed optimism about the endeavor’s capacity to extend tobacco cessation reach and magnify positive health outcomes. Complementing this, Dr. Sterba emphasized the importance of adaptive, context-sensitive models and envisaged dissemination of successful strategies not only throughout South Carolina but also on a broader national scale. Together, their interdisciplinary collaboration embodies a translational research paradigm that bridges evidence generation with real-world clinical application.

This initiative exemplifies the transformative potential of pharmacist-led tobacco cessation interventions embedded within specialized care settings. By harnessing pharmacists’ accessibility and expertise, the ENHANCE-TTS program is poised to fill critical gaps in tobacco treatment for people living with HIV. The research stands at the forefront of implementation science, marrying clinical innovation with system-level integration to enhance population health.

As the program advances, its findings will illuminate pathways toward scalable, sustainable tobacco cessation models that can be replicated in diverse healthcare systems confronting high smoking prevalence among vulnerable populations. By confronting the intersection of HIV care and tobacco control, this pioneering work seeks not merely to improve individual quit rates but to engender systemic change that elevates overall quality of life and reduces cancer-related morbidity and mortality for people living with HIV.

Subject of Research: Tobacco cessation interventions for people living with HIV through pharmacist-led training programs in HIV care clinics.

Article Title: Pharmacist-Led Tobacco Cessation: A Novel Approach to Reducing Lung Cancer Mortality Among People Living with HIV

News Publication Date: Not specified

Web References:

• Medical University of South Carolina faculty directory: Alana Rojewski
• Medical University of South Carolina faculty directory: Katherine Sterba
• Medical University of South Carolina: musc.edu
• MUSC Health: muschealth.org

Image Credits: Medical University of South Carolina. Photo by Cliff Rhodes.

Keywords: HIV, tobacco cessation, lung cancer, pharmacist training, implementation science, HIV clinics, smoking cessation, Ryan White clinics, public health, tobacco treatment specialists, clinical pharmacy, evidence-based interventions

Tuberculosis remains a significant global health challenge. In 2023 alone, TB accounted for 1.25 million deaths worldwide, with a concerning 13% of those fatalities occurring among individuals living with HIV. The traditional diagnostic approach hinges fundamentally on the collection and analysis of sputum samples, which involve a physically demanding process of deep coughing to expectorate lung secretions. This method has been the cornerstone of TB diagnosis as recommended by international health organizations like the World Health Organization (WHO). However, as the research highlights, such techniques are fraught with limitations, especially for individuals battling advanced stages of HIV.

One of the central tenets of the study emphasizes that many individuals living with HIV often face difficulties in producing adequate sputum samples. It has been observed that over half of patients with advanced AIDS are unable to provide these crucial samples. Moreover, even when sputum samples are obtained, the concentration of Mycobacterium tuberculosis can be prohibitively low, rendering standard diagnostic tests ineffective. In light of these challenges, researchers sought an alternative that could offer a reliable diagnostic avenue for this vulnerable demographic.

The Stool4TB project, supported by the European and Developing Countries Clinical Trials Partnership (EDCTP), aimed to explore the feasibility of employing the Xpert MTB/RIF Ultra test on stool samples. This molecular diagnostic tool, currently in use for respiratory samples, has already been notably beneficial for pediatric patients who also struggle with sputum production. The backdrop for this research involved extensive fieldwork, with trials taking place across three African nations – Eswatini, Mozambique, and Uganda – between December 2021 and August 2024. A substantial cohort of 677 patients aged 15 and older was enlisted, all living with HIV and suspected of having TB, allowing researchers to gather a diverse array of biological samples, including sputum, urine, stool, and blood.

Amidst the clinical landscape, the challenges associated with diagnosing TB in patients with HIV infections are particularly pronounced. As George William Kasule, a promising doctoral candidate at ISGlobal, points out, individuals living with HIV exhibit a heightened susceptibility to pulmonary tuberculosis, yet conventional diagnostic tests often fall short in sensitivity. This discrepancy underlines the necessity for alternative testing methods that can capture a broader spectrum of potential TB cases. The research team utilized a microbiological reference standard based on three WHO-recommended tests to establish a comparison with the results from the Stool Ultra test.

The findings from this comprehensive study reveal critical insights. The sensitivity of the stool-based Xpert Ultra test was observed to be 23.7%, with an impressive specificity rate of 94%. However, what is particularly striking is how sensitivity escalated to 45.5% among patients with CD4 counts falling below 200 cells/μl. This marker is indicative of advanced HIV disease, and it is within this population where the risk of contracting opportunistic infections such as tuberculosis intensifies. The results prompt a broad re-evaluation of existing diagnostic practices, advocating for the integration of stool testing as an adjunctive tool for TB diagnosis.

Dr. Alberto L. García-Basteiro, a leading researcher at ISGlobal and the head of the Vaccine and Immune Response to Infections Unit at Hospital Clínic de Barcelona, emphasizes the transformative nature of these findings. The Stool Ultra test can not only identify additional TB cases that standard tests like TB-LAM, sputum Ultra, or culture may overlook, but it also offers a level of efficacy that is comparable to conventional sputum tests for patients in advanced AIDS stages. This insight brings to light a crucial benefit of utilizing stool samples – the ability to affirm a diagnosis even in scenarios where respiratory specimen collection is not feasible or fails to provide conclusive results.

As such, the potential of utilizing stool samples for TB detection, particularly in populations with HIV, is underscored by the pressing need for improved diagnostic strategies. The study demonstrates that such non-invasive methods can play a pivotal role in enhancing TB diagnosis in adults facing significant health challenges. This paradigm shift could usher in a new era of TB diagnostics, underscoring a glaring need for accessible and reliable testing methods that cater to the unique needs of populations traditionally marginalized in clinical diagnostics.

In summary, the findings from the Stool4TB project illuminate the viability of stool samples as an essential component in the diagnostic toolkit for tuberculosis, especially for individuals living with HIV. With substantial data backing this approach, healthcare providers and policymakers are urged to reconsider existing diagnostic frameworks that primarily rely on sputum samples. The emerging evidence from this research supports the notion that by embracing innovative testing methods, significant strides can be made toward combating the global TB epidemic—ultimately reducing morbidity and mortality in one of the most vulnerable populations today.

The significance of these findings cannot be overstated. As researchers continue to refine and expand upon the application of the Xpert MTB/Ultra test for stool samples, the overarching goal remains clear: to enhance accuracy in TB diagnosis, particularly for those who face barriers to traditional testing methods. The landscape of TB diagnostics is poised for a substantial evolution, and the implications of this research hold the promise of saving lives and improving health outcomes for countless individuals worldwide.

Subject of Research: People Living with HIV and Tuberculosis
Article Title: Stool Tests Could Revolutionize Tuberculosis Diagnosis in HIV-Positive Adults
News Publication Date: October 2023
Web References: https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(25)00013-8/fulltext
References: Kasule, G., Hermans, S., Acacio, S., et al, Performance of stool Xpert MTB/RIF Ultra for detection of Mycobacterium tuberculosis among adult people living with HIV: a prospective multicentre diagnostic study. Lancet Microbe (2025).
Image Credits: Not Available

Keywords: Tuberculosis, HIV, Diagnostic Testing, Public Health, Molecular Diagnostics, Stool Sample Analysis, CD4 Count, Xpert MTB/RIF Ultra.