From the beginning of her career, Dr. Lauren Pacek has been interested in conducting research with vulnerable populations. During her undergraduate program, she volunteered in a professor’s lab where the focus was on smoking cessation. Then, in graduate school, she began working with populations living with HIV. Today, Dr. Pacek is an Assistant Professor in Psychiatry and Behavioral Sciences in Duke’s School of Medicine. She has a background in public health and, while she still loves epidemiology, she realized that being in a medical center at Duke was the perfect environment for working on her ultimate goal of intervention-based research.
Once at Duke, Dr. Pacek began working with Joseph McClernon, Ph.D., whose research focuses on mobile health (mHealth) applications. This was a new concept to her but she soon discovered that she could use mHealth methods to improve smoking cessation among people living with HIV. Inspired by Dr. McClernon’s mHealth research, Dr. Pacek’s current study is a trial using a mobile phone application (app) to increase medication adherence. She hopes to eventual apply this method to a variety of populations and medications.
“Adherence is hard. It’s hard for everybody” – Dr. Pacek
As adherence to smoking cessation medications can be difficult for the general population, Dr. Pacek describes that it can be especially difficult among people living with HIV. Dr. Pacek’s current study is recruiting a sample of people living with HIV and giving them a free supply of Chantix, a popular smoking cessation medication. Two-thirds of participants in the study will receive the supply of Chantix plus will use a mobile phone app that provides reminders to take the medication and asks about specific barriers to adherence. The remaining one-third of participants will receive Chantix only. Based on participants’ responses in the app, it will provide brief psychoeducation, tips, and tricks to help them overcome their barriers. A common side effect of Chantix, for example, is nausea. The app will ask if the participant is experiencing any nausea and if so, it will push information about how to offset it, such as eating a meal or drinking a tall glass of water when taking the medication.
Dr. Pacek anticipates that the application will increase adherence to smoking cessation medications by encouraging people to take them as directed. She and her colleagues have been testing the app in the general population of smokers at Duke, and it has been adapted to test for pre-exposure prophylaxis (PrEP) adherence among men who have sex with men (MSM), a population at increased risk of contracting HIV.
Dr. Pacek is also co-PI on another mHealth project with Dr. Roger Vilardaga. This two-phase study uses an app designed by Dr. Vilardaga and aims to increase smoking session directly. In phase one, 12 smokers living with HIV will be recruited to individually test the app and provide feedback. Dr. Pacek and Dr. Vilardaga will then tailor the app based on this feedback. Phase two will consist of a pilot trial of the app in smokers living with HIV who are interested in quitting. These participants will be randomized to either receiving the tailored app or the current standard of care—the NCI quit-smoking guide. The researchers will follow participants for several months to determine if their tailored app increases smoking cessation.
Dr. Pacek says she is always open to collaboration. With her two mHealth studies, she is hoping to create an app that is not only focuses on smoking cessation medications, but also includes antiretroviral therapy (ART) medications and medications for other comorbidities like hypertension. Ultimately, she would like to see this mHealth app become a comprehensive packed intervention.
While working to increase tobacco cessation, however, she recognized that quitting nicotine products is generally very hard. Coupled with the fact that some people do not wish to quit nicotine altogether, she is interested in taking a harm reduction approach to tobacco use, especially among people living with HIV. She is currently working on a grant submission with an aim to transition cigarette smokers living with HIV to tobacco products that may have a less harmful risk profile, and then she will assess whether this is acceptable to patients, as well as assessing the resulting health outcomes to ascertain if this is a prudent intervention from a health perspective.
“I’m hoping that, because harm reduction has been so embraced by this research community, that tobacco harm reduction will also be viewed as acceptable. Harm reduction can be a 4-letter word in the tobacco community depending on who you talk to, so I’m hoping that the tobacco and HIV community is more accepting.” – Dr. Pacek
CFAR SBS Core Assistance
The CFAR SBS Core has an abundance of services we offer to Duke HIV researchers. Dr. Pacek first officially used these services when she participated in a mock grant interview for her K01 award to study the mHealth app and adherence to Chantix. She described that the feedback received led to a stronger submission; she plans to use this service more often in the future. She is also very excited to participate in future brainstorming sessions to get several people with similar expertise in the same room and consider ideas for future research. The SBS Core Leadership is also excited to make these brainstorming sessions happen.
“I have to say that whenever my colleague, Roger, and I went to the mixer a couple of weeks ago, we were both floored by the services that are available to us [through the SBS Core]”
The SBS Core offers a wealth of services to our members and all HIV researchers at Duke including early planning and grant preparation consultations; peer reviews of grants, manuscripts, conference presentations, etc.; post-award consultations; training and capacity building; networking and community engagement; mentoring; and dissemination of study findings and other manuscript preparation. Visit our website to learn more and click here to send a request for any of these services.