Multilevel barriers and facilitators to smoking cessation among men living with HIV in Vietnam: a qualitative study of male patients and healthcare providers

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. 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. 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. 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. ClinicalTrials.gov NCT05162911. Registered on December 16, 2021.