Abstract 78: A Mixed-Methods Assessment of Factors Associated with Sustained Delivery of Tobacco Use Treatment in HIV Clinics in Vietnam

Abstract Purpose: Factors influencing sustainability of health programs are understudied in low-and middle- income countries (LMICs). We conducted a type 2 hybrid RCT that compared the effectiveness of three tobacco use treatments (TUTs) among people living with HIV (PLWH) receiving care in HIV clinics in Vietnam and concurrently evaluated the impact of implementation strategies (e.g. training) used to increase adoption of the treatment options. All patients received brief counseling (ask, advice, assist) and were then randomized to receive either referral to national Quitline (3As+R), 6-session nurse-delivered counseling (C), or C + nicotine replacement gum. Methods: We conducted baseline, 12- and 18-month surveys of health care providers (79 across 14 clinics) and in-depth interviews with 18 healthcare providers, and 2 district health directors. Interviews were recorded, transcribed into Vietnamese, and translated/back translated into English. Four team members independently open-coded 20% of transcripts and developed a codebook through an iterative process to achieve consensus. At least two team members then used this codebook to recode all transcripts and extract themes related to sustaining TUTs. Results: Adoption of 3As increased significantly in 12 months and was sustained at 18 months. We identified five major themes that may influence sustainability: alignment of TUT with HIV treatment goals (“Cigarettes problem is related to my ARV medication and health of my patients..”); attitudes towards prioritizing co-morbid conditions within HIV care (“It is best if you can integrate it [TUT]…we provide holistic care…it is not time-consuming for the patients and many problems to be improved at the same time.”), intervention sustainment (“...brief counseling and transfer to Quitline is very easy, intensive counseling takes a lot of time of staff as well patient.”), need for external support (“…we lack financial resources…if this is not institutionalized, we cannot obtain funds from the state budget.”) and leadership buy-in (“…key to maintaining is certainly from the leadership side…if the leader doesn’t want to maintain it…we can’t do it, we are not allowed to.”). Conclusion: This research is expanding our understanding of factors that influence sustainability of integrating a noncommunicable disease prevention intervention in LMIC health care settings serving PLWH. Citation Format: Reet Kapur, Claire Nguyen, Gloria G. Alvarez, Trang Nguyen, Nam Nguyen, Charles M. Cleland, Lloyd Goldsamt, Mari Armstrong-Hough, Donna R. Shelley. A Mixed-Methods Assessment of Factors Associated with Sustained Delivery of Tobacco Use Treatment in HIV Clinics in Vietnam [abstract]. In: Proceedings of the 13th Annual Symposium on Global Cancer Research; 2025 Sep 16. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(12_Suppl):Abstract nr 78.