Patterns and Correlates of Tobacco Use Among PLWH in Viet Nam: A Cross-Sectional Analysis.

Introduction: The use of multiple tobacco products may increase nicotine dependence and reduce success in quitting. In Viet Nam, the prevalence of dual cigarette and waterpipe use is high, yet the characteristics of dual users, particularly among people living with HIV (PLWH) in low-and-middle income countries (LMICs) are underexplored. This paper describes patterns and correlates of tobacco use among PLWH in Viet Nam. Methods: This cross-sectional analysis utilized baseline survey data from a randomized controlled trial. Participants (n = 672) were ≥ 18 years old, current cigarette smokers, and receiving care at one of 13 HIV clinics in Ha Noi. Tobacco use pattern (cigarette-only vs dual waterpipe and cigarette use) was determined by self-reported use in the past 7 days. Sociodemographic characteristics, health status, household smoking rules, substance use, and perceived smoking risks were examined using bivariate analysis, with Wilcoxon's rank sum test and Pearson's Chi-sq tests used to assess statistical significance. Results: Half of the sample (50.3%) reported dual waterpipe and cigarette use. Dual use was significantly associated with a lower level of education, lower annual income, and poorer health compared to cigarette-only smokers. Dual users were less likely to report a no-smoking household policy, and more likely to have a higher level of nicotine dependence. Participants from both user groups perceived waterpipe smoking as less harmful compared to cigarette smoking. Conclusion: There is a high prevalence of dual tobacco use among PLWH in Viet Nam. Understanding the characteristics of dual users is critical for developing comprehensive tobacco control policies and cessation strategies tailored to this population in Viet Nam and other LMICs.