Background China, where half of the adult male population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV. People with HIV can be affected by smoking in multiple ways, including more severe HIV-related symptoms and worse antiretroviral therapy treatment outcomes. However, smoking cessation services targeted for people with HIV are not routinely integrated into HIV care in China. Given the widespread mobile phone ownership, an exploration of factors related to smoking among people with HIV in China who smoke could inform the design and implementation of mobile smoking cessation interventions that target the needs of this vulnerable population. Objective This study aims to explore the perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief daily messenger service (WeChat)–delivered messages. Methods We recruited people with HIV from the People’s 4th Hospital of Nanning, Guangxi, China, and conducted semistructured face-to-face interviews. All interviews were audio-recorded, transcribed verbatim in Chinese, and translated into English for data analysis. We conducted a thematic analysis using a codebook, which was guided by a team-based consensus approach to identify 5 main themes. We also explored themes according to the demographic groups. Results A total of 24 participants were enrolled in the study. The mean age was 37.2 (SD=13.5) years. The participants had lived with HIV for a mean of 2.4 years. The majority were male (18/24, 75%) and lived in urban or metropolitan settings (19/24, 79%). We identified five main themes: variable knowledge of the harms of smoking, both related and unrelated to HIV; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (eg, messages should be brief and most frequent during the first few weeks); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed according to participant demographic characteristics such as age, sex, and education level. Conclusions We identified barriers to and facilitators of smoking cessation among people with HIV in China by conducting semistructured qualitative interviews. Owing to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of people with HIV in China may be needed to increase the effectiveness of future interventions. A pilot clinical trial will be conducted in the future to evaluate this behavioral counseling and brief daily messenger service (WeChat)–delivered messages approach among people with HIV who smoke in China.

BACKGROUND China, where over half of the male adult population smoke tobacco, has one of the highest global burdens of smoking. Smoking rates are even higher among people with HIV (PWH). Smoking cessation services are not routinely integrated into HIV care in China. Given widespread mobile phone ownership, an exploration of factors related to smoking among Chinese PWH who smoke could inform potential mobile cessation interventions. OBJECTIVE To explore perspectives of smoking, barriers and facilitators to quitting, and perceptions related to a smoking cessation intervention delivered through behavioral counseling sessions and brief messenger service-delivered messages. METHODS We conducted semi-structured interviews with 24 participants. Interviews were audio-recorded, transcribed verbatim in Chinese, then translated into English for data analysis. We conducted a thematic analysis using a team-based consensus approach. RESULTS The mean age was 37.2 years; participants lived with HIV for an average of 2.4 years. The majority were male (75%) and lived in urban/metropolitan settings (79%). We identified 5 main themes: variable knowledge of the harms of smoking; willpower perceived as the primary quitting strategy; a duality of the effect of social factors on quitting; perceptions about optimal features of the smoking cessation intervention (e.g., messages should be brief and frequent); and the largely negative impact of their HIV diagnosis on smoking behaviors. In addition, some themes differed by participant demographic characteristics. CONCLUSIONS We identified barriers and facilitators to smoking cessation among PWH in China, which can be incorporated into smoking cessation interventions using behavioral counseling and messenger service-derived brief messages. Due to the adverse impact of smoking on HIV outcomes, targeting cessation interventions to the unique needs and preferences of PWH in China may be needed to increase future intervention effectiveness.