Abstract 64: Multilevel Barriers and Facilitators of Smoking Cessation in People Living With HIV in Vietnam: A Qualitative Analysis
Authors: Hoang Thanh , Nguyen Claire VT , Alvarez Gloria Guevera , Nguyen Trang , Nguyen Nam , Adermark Louise , Ng Nawi , Shelley Donna , Armstrong-Hough Mari 
Published: June 2023

Abstract
Purpose: In Vietnam, tobacco smoking is highly prevalent among people living with HIV (PLWH) and increases their risk of cancer, cardiovascular disease, and life-threatening opportunistic infections. However, research on effective tobacco use treatment (TUT) for PLWH is lacking. To fill this gap, we aimed to identify multilevel barriers and facilitators (B&Fs) of smoking cessation and their implications for TUT implementation for PLWH in Hanoi, Vietnam.
Methods: We conducted individual in-depth interviews with 24 patients and 13 healthcare providers at three HIV outpatient clinics (OPCs) in Hanoi to explore B&Fs of smoking cessation at the patient, provider, and system level. Two coders carried out a two-phase abductive thematic analysis using Atlas.ti and guided by the Theoretical Domains Framework.
Results: Participants described several patient-level barriers to smoking cessation: limited knowledge, misperceptions about smoking harms, lack of familiarity with cessation aids, exposure to environments in which smoking is common, emotional issues (i.e., stress/depression), substance use, and social norms that promote male smoking and tie smoking to masculinity. Both patients and providers described self-determination to quit as a major facilitator of smoking cessation (Everything can be overcome if there is determination). Patients reported that strong determination to quit is influenced by concerns about the harms of smoking; family support and pressure to quit; and the potential for improving health of themselves and their family and for reducing tobacco-related expenses from tobacco purchases. Provide-reported barriers included a lack of resources and capabilities to assess and intervene on smoking behaviour at the OPCs, and at the system level affordable and accessible tobacco products. However, providers endorsed the importance of supporting patients to quit and were optimistic about tailoring and integrating TUT into OPCs if they were equipped with training, personnel, and financial support. Trust and patient-provider solid relationships were potential facilitators of cessation.
Conclusion: The study suggested the need to intervene at patient, provider, and system levels to increase engagement among PLWH in smoking cessation treatment. Provider training, patient education and resources are needed to facilitate treatment. Findings also suggest a need to tailor existing treatment options developed in other contexts to this population and setting.
Citation Format: Thanh Hoang, Claire VT Nguyen, Gloria Guevera Alvarez, Trang Nguyen, Nam Nguyen, Louise Adermark, Nawi Ng, Donna Shelley, Mari Armstrong-Hough. Multilevel Barriers and Facilitators of Smoking Cessation in People Living With HIV in Vietnam: A Qualitative Analysis [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 64.