Tobacco smoking and associated factors among people living with HIV in Uganda.

INTRODUCTION This study aimed to assess smoking patterns, behaviours and associated factors among people living with HIV (PLWH) in Uganda. METHODS A cross-sectional survey was conducted among adults in HIV care in Uganda. Descriptive statistics were used to describe smoking patterns and behaviours. Logistic regression was used to identify factors associated with current smoking status. RESULTS We recruited 777 participants between October and November 2019: 387 (49.8%) current smokers and 390 (50.2%) non-smokers. 60.9% were males, and the mean age was 40.5 (SD 10.7) years. In multivariate logistic regression, the following increased the odds of being a current smoker: being male (OR 6.60 (95%CI= 4.34 to 10.04)), having at least two smokers among five closest friends (OR 3.97 (95%CI= 2.08 to 7.59)), living in smoking-permitted households (OR 5.83 (95%CI= 3.32 to 10.23)), alcohol use (OR 3.96 (95%CI= 2.34 to 6.71)), a higher perceived stress score (OR 2.23 (95%CI= 1.50 to 3.34)), and higher health-related quality of life (OR 5.25 (95%CI= 1.18 to 23.35)). Among smokers, the mean Fagerstrom Test for Nicotine Dependence score was 3.0 (SD 1.9), and 52.5% were making plans to quit. Self-efficacy to resist smoking and knowledge of the impact of smoking on PLWH's health were low. CONCLUSIONS Being male, having at least two smokers among five closest friends, living in smoking-permitted households, alcohol use, higher perceived stress scores and higher health-related quality of life were associated with being a current smoker. Smokers had low to moderate nicotine dependence, high willingness to quit, and low self-efficacy. IMPLICATIONS Future behavioural smoking cessation interventions for PLWH should address co-consumption with alcohol and comorbid mental health conditions that are common among PLWH such as stress. In addition, they should take into account the lack of knowledge among this population of the impact of smoking on their health, and low self-efficacy. Given the relatively low levels of nicotine dependency and high levels of willingness to quit in our sample, smoking cessation interventions, if offered, are likely to support this population in achieving long-term smoking abstinence.