Thanh Ha-Lan Hoang

Background: In Vietnam, smoking remains highly prevalent among people living with HIV (PLWH), posing significant health risks. As PLWH receiving HIV care represent a selected population that may differ from the general smoking population, evidence on the psychosocial factors shaping readiness to quit in this group remains limited. This study examines the associations between tobacco-related risk perception, self-efficacy, and social norms with advanced readiness to quit among PLWH who smoke and were enrolled in a smoking cessation trial in Vietnam. Methods: We conducted a secondary cross-sectional analysis of baseline data from the VQUIT randomized controlled trial, including 672 PLWH who currently smoked cigarettes some days or every day, recruited from 13 HIV outpatient clinics in Hanoi, Vietnam. Advanced readiness to quit was defined as currently trying to quit or planning to quit within 30 days; all other responses were classified as lower or no readiness. Multivariable logistic regression models with robust standard errors, clustered at the clinic level, were fitted to examine associations between risk perception, self-efficacy, four social norm constructs, and advanced readiness to quit. Results: Overall, 76.6% of participants reported advanced readiness to quit. Higher risk perception was consistently associated with increased odds of advanced readiness to quit (aORs ranged 1.10 to 1.13 across models). Injunctive norms (aOR=1.11, 95% CI: 1.03–1.20) and internalized norms (aOR=1.40, 95% CI: 1.02–1.94) were positively associated with advanced readiness to quit, while descriptive and subjective norms were not. Self-efficacy showed no significant association. Conclusion: Among PLWH enrolled in a smoking cessation trial in Vietnam, higher risk perception and stronger injunctive and internalized norms were associated with advanced readiness to quit. Cessation interventions integrated into HIV care may benefit from addressing both perceived smoking-related risks and norm-based motivations to quit.

Background: In Vietnam, tobacco smoking is highly prevalent among people living with HIV. However, research on engaging this population in tobacco use treatment is limited. To fill this gap, we aimed to identify barriers and facilitators to smoking cessation and examine implications for the design and implementation of tobacco use treatment for people living with HIV in Vietnam. Methods: We conducted in-depth interviews with 24 patients and 13 healthcare providers at three HIV outpatient clinics in Hanoi to explore barriers to and facilitators of smoking cessation at the patient-, provider-, and system levels. We conducted an abductive thematic analysis guided by the Theoretical Domains Framework. Results: Patient-level barriers to smoking cessation included patients’ perception that smoking is not an immediate threat to their health and does not impact HIV outcomes, lack of familiarity with cessation aids, stress, emotional distress, nicotine dependence, exposure to environments in which smoking is common, and social norms that promote male smoking and link smoking to masculinity. Patients and providers also described having “determination” to quit as an important precursor for making a quit attempt. Providers reported barriers to offering treatment, including lack of skills, knowledge, and competing demands related to treating tobacco use. However, they embraced their role in helping patients quit and described trusting relationships with patients as a potential facilitator of engaging smokers in cessation treatment. At the system level, both patients and providers identified easy access and affordability of tobacco products as barriers to cessation. Conclusion: This study identified opportunities for increasing engagement in tobacco use treatment at the patient, provider, and system levels. Provider training to deliver treatment, patient education about the health implications of continuing to smoke, system changes that support the integration of treatment into routine care, and revision of tobacco taxation are needed. Trial registration: ClinicalTrials.gov NCT05162911. Registered on December 16, 2021.

Background: People living with HIV (PLWH) who smoke face significant health risks from tobacco use, which dual use of cigarettes and waterpipes may exacerbate due to increased nicotine exposure and dependency. This study examined the sociodemographic, behavioral, psychosocial and health-related factors associated with dual smoking among PLWH receiving care at HIV clinics in Hanoi, Vietnam. Methods: This cross-sectional study used baseline survey data from the VQUIT study, an RCT of smoking cessation interventions involving 662 PLWH from 13 outpatient clinics in Vietnam. Eligible participants were current tobacco smokers; dual smokers were those using both cigarettes and waterpipes. Multivariable logistic regression was used to identify factors associated with cigarette-only and dual use among PLWH. Results: Over half of the study participants were dual smokers. Dual smoking was associated with a lower annual income (aOR: 1.91, 95%CI: 1.08–3.38) and higher nicotine dependence (aOR: 2.31, 95%CI: 1.62–3.31). They were less likely to report a prior quit attempt (aOR: 0.47, 95% CI: 0.33–0.68), more likely to perceive cigarettes as more harmful (aOR 1.44, 95% CI: 1.01–2.09), and more likely to report recent illicit drug use (aOR: 2.32, 95% CI: 1.26–4.24) and longer antiretroviral treatment duration (aOR: 1.06, 95% CI: 1.03–1.10). Social support for quitting lowered the odds of dual smoking (aOR: 0.62, 95% CI: 0.39–0.97). Conclusions: Dual smoking was prevalent among PLWH receiving HIV care in VQUIT study and was shaped by complex sociodemographic, behavioral, and social factors. These findings emphasize the need for integrated cessation interventions in Vietnam, where dual smoking is prevalent, particularly among PLWH. Socioeconomic status and barriers to quitting, including drug use, nicotine dependence, and tobacco-related misconceptions, should be considered. Future research should examine the long-term health impacts of dual smoking and evaluate cessation strategies for PLWH in similar settings.

Tobacco smoking is highly prevalent among people living with HIV (PLWH), yet there is a lack of data on smoking behaviours and effective treatments in this population. Understanding factors influencing tobacco smoking and cessation is crucial to guide the design of effective interventions. This systematic review and meta-analysis of studies conducted in both high-income (HICs) and low- and middle-income countries (LMICs) synthesised existing evidence on associated factors of smoking and cessation behaviour among PLWH. Male gender, substance use, and loneliness were positively associated with current smoking and negatively associated with smoking abstinence. The association of depression with current smoking and lower abstinence rates were observed only in HICs. The review did not identify randomised controlled trials conducted in LMICs. Findings indicate the need to integrate smoking cessation interventions with mental health and substance use services, provide greater social support, and address other comorbid conditions as part of a comprehensive approach to treating tobacco use in this population. Consistent support from health providers trained to provide advice and treatment options is also an important component of treatment for PLWH engaged in care, especially in LMICs.