A qualitative investigation of tobacco use and cessation experiences among people living with HIV in Botswana.

BACKGROUND: Tobacco use is a leading cause of premature mortality among people living with HIV (PLWH), especially in Botswana, where high smoking rates coincide with successful HIV control. There is a need for evidence-based interventions to support smoking cessation among PLWH, but research on smoking cessation in Botswana is limited. Therefore, to address this gap, a qualitative study was conducted in Botswana to understand the experiences of PLWH who smoke and identify barriers and facilitators to quitting in preparation for a larger implementation trial. METHODS: In 2024, 36 interviews were conducted with adult patients who smoke from five HIV care sites in Botswana. Participants were purposively sampled by cessation outcome: successfully quit (n = 13), returned to use (n = 8), and did not quit (n = 15). The interviews aimed to gather insights into smoking cessation barriers and facilitators, including behavioral and motivational factors. The interviews were recorded, transcribed, and translated from Setswana to English, then were analyzed using a hybrid deductive-inductive thematic analysis approach. FINDINGS: Results showed notable differences in the reasons for starting and continuing to smoke. Despite strong motivations to quit, such as reducing financial, health, and social burdens, participants encountered obstacles such as withdrawal symptoms and life stressors. Participants also identified various strategies to aid quitting like eating candies and attending church, and expressed readiness to use medical services such as cessation medications. CONCLUSION: Overall, participants expressed a strong desire for interventions to help them quit smoking. Effective interventions could focus on managing withdrawal symptoms and utilizing existing patient motivations and social supports.Clinical Trial Registration NCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search? locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at https://doi.org/10.1186/s12982-026-02813-1.