BMC public health · 2025
Multilevel drivers of tobacco use among people living with HIV in West Nile and Karamoja Regions in Uganda: a mixed-methods study.
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Musasizi Ezekiel, Wipfli Heather, Arinaitwe Jim, Atuyambe Lynn, Guy Kyra, Kusolo Ronald, Rutebemberwa Elizeus, Guwatudde David
Аннотация
BACKGROUND: Tobacco use is a significant public health problem, especially among People Living with HIV (PLWH) yet evidence on its prevalence and multi-level drivers in Uganda remains limited. This study assessed the prevalence and multilevel drivers of tobacco use among PLWH in two regions in northern Uganda.
METHODS: We conducted a mixed-methods study involving a survey of 439 PLWH randomly sampled from eight health facilities in West Nile and Karamoja regions and Focus Group Discussion (FGDs) of 47 PLWH to understand multi-level drivers of tobacco use. Data was collected from August 15th to December 20th, 2024. Survey data was collected electronically using Open Data Kit (ODK) platform. Tobacco use was biochemically verified using cotinine urine dipsticks. We conducted quantitative analysis to identify factors associated with tobacco use using multinomial regression model using STATA v14. Qualitative data was analyzed using thematic analysis in NVivo V15.
RESULTS: According to self-reports, Tobacco use was more prevalent in Karamoja than in West Nile, with smokeless tobacco dominating in Karamoja and smoking more common in West Nile. Nicotine dependence was higher among smokers (49.1%) than smokeless users (32.1%). Smoking was associated with being male (RRR = 11.13; 95% CI, 5.08-24.41) and having lower tobacco realted - knowledge (RRR = 0.39; 95% CI, 0.17-0.90). Smokeless tobacco use was associated with district of residence (RRR = 177.57; 95% CI, 29.36-1074.02) and other substance use (RRR = 4.08; 95% CI, 1.06-15.64). FGDs revealed multi-level drivers spanning the intrapersonal level (addiction, HIV-related distress, gender norms, and limited knowledge), interpersonal level (peer and family influence), community level (cultural practices and stigma), organizational level (tobacco affordability and inadequate cessation services), and the policy level, where limited awareness and weak enforcement of existing smokeless tobacco regulations contributed to continued use of tobacco.
CONCLUSION: Tobacco cessation strategies should be mode-specific and context-sensitive. In West Nile, where smoking and dual use are common, interventions should target men with low tobacco-related knowledge. In Karamoja, where smokeless tobacco is culturally entrenched and enforcement of existing bans is weak, cessation requires community-based education, facility-based treatment, and post-care support. Addressing multi-level drivers is essential for tobacco use cessation among PLWH in similar settings.
METHODS: We conducted a mixed-methods study involving a survey of 439 PLWH randomly sampled from eight health facilities in West Nile and Karamoja regions and Focus Group Discussion (FGDs) of 47 PLWH to understand multi-level drivers of tobacco use. Data was collected from August 15th to December 20th, 2024. Survey data was collected electronically using Open Data Kit (ODK) platform. Tobacco use was biochemically verified using cotinine urine dipsticks. We conducted quantitative analysis to identify factors associated with tobacco use using multinomial regression model using STATA v14. Qualitative data was analyzed using thematic analysis in NVivo V15.
RESULTS: According to self-reports, Tobacco use was more prevalent in Karamoja than in West Nile, with smokeless tobacco dominating in Karamoja and smoking more common in West Nile. Nicotine dependence was higher among smokers (49.1%) than smokeless users (32.1%). Smoking was associated with being male (RRR = 11.13; 95% CI, 5.08-24.41) and having lower tobacco realted - knowledge (RRR = 0.39; 95% CI, 0.17-0.90). Smokeless tobacco use was associated with district of residence (RRR = 177.57; 95% CI, 29.36-1074.02) and other substance use (RRR = 4.08; 95% CI, 1.06-15.64). FGDs revealed multi-level drivers spanning the intrapersonal level (addiction, HIV-related distress, gender norms, and limited knowledge), interpersonal level (peer and family influence), community level (cultural practices and stigma), organizational level (tobacco affordability and inadequate cessation services), and the policy level, where limited awareness and weak enforcement of existing smokeless tobacco regulations contributed to continued use of tobacco.
CONCLUSION: Tobacco cessation strategies should be mode-specific and context-sensitive. In West Nile, where smoking and dual use are common, interventions should target men with low tobacco-related knowledge. In Karamoja, where smokeless tobacco is culturally entrenched and enforcement of existing bans is weak, cessation requires community-based education, facility-based treatment, and post-care support. Addressing multi-level drivers is essential for tobacco use cessation among PLWH in similar settings.