Tobacco cessation prescription rates among Veterans living with human immunodeficiency virus who smoke

<i>Introduction:</i> Cigarette smoking remains the leading preventable cause of death in the United States, with prevalence remaining dangerously high in at-risk groups, including people living with Human Immunodeficiency Virus (HIV). Military Veterans with HIV and receiving Veterans Health Administration (VHA) care have a high prevalence of smoking, and risk factors such as hazardous drinking and substance use disorder (SUD), despite access to smoking cessation treatment. Little is known about the prevalence of smoking and smoking cessation medication receipt among Veterans with HIV and co-occurring hazardous drinking or SUD. <i>Methods:</i> In this cohort study, we analysed nationwide VHA electronic health record (EHR) data from 1 October 2015 to 30 September 2021, to examine the prevalence of smoking among Veterans with HIV with and without hazardous drinking or SUD diagnoses. We then assessed VHA cessation prescription rates for the 12 months following the documentation of smoking in the VA EHR. <i>Results:</i> In the overall sample of Veterans with HIV who smoke and have co-occurring hazardous drinking or SUD, 33.9% (<i>N</i> = 3220) were prescribed smoking cessation medications in the 12 months following documented smoking. Among Veterans who smoke with HIV, 42.5% of those with hazardous drinking or SUD were prescribed medication compared to 29.6% of those without hazardous substance use. <i>Discussion:</i> These trends demonstrate that Veterans with HIV who smoke but do not have hazardous drinking or SUD have lower access to smoking cessation pharmacotherapy in VA care. Efforts to provide tobacco cessation pharmacotherapy to this population may improve smoking outcomes.<b>Trial registration:</b> Netherlands National Trial Register identifier: ntr206.