Project Summary This supplement proposes a longitudinal study that will extend the parent’s grant current portfolio to examine the difference in household food insecurity among people living with HIV (PLWH) and the relationship between food insecurity and tobacco use in Vietnam. The supplement focuses on how decreased food insecurity may have significant impact in the health disparities experienced on PLWH as chronic and infectious diseases intersect; and the study is powered to assess the potential impact of smoking cessation on food insecurity. The study aims are 1) to estimate the difference in household food insecurity among PLWH who smoke compared with PLWH who are non-smokers at baseline, and 2) to examine mechanisms linking smoking and household food insecurity among PLWH at baseline and 6-months follow-up, and 3) to assess the impact of a reduction in tobacco use and tobacco cessation on measures of food Insecurity at 6-month follow-up. Using a longitudinal design with a matched comparison population we will assess and compare the prevalence of food insecurity at the household level among individual HIV+ smokers and non-smokers and explore mechanisms associated with food insecurity among PLWH (smokers and non-smokers); and assess the potential impact of smoking cessation on food insecurity. We hypothesize that HIV+ smokers who have quit smoking or reduced cigarettes smoked per day by more than 50% will on average experience lower food insecurity than HIV+ smokers who continued to smoke. Findings from this study will help to better understand how screening for food insecurity may be incorporated in multipronged treatment programs in a resource poor setting, thereby identifying food insecure patients, which may help to alleviate the negative impact of co-occurring conditions and to inform policies and programs that address cessation interventions. The supplement builds on the parent grant which addresses the high prevalence of smoking in Viet Nam among PLWH. The long-term goal of the grant is to develop a scalable model for implementing evidence-based tobacco use treatment in health care settings treating PLWH in LMICs. The objective the grant is to conduct a 3-arm randomized controlled trial that compares the effectiveness and cost-effectiveness of three practical multilevel, multicomponent tobacco cessation interventions in outpatient clinics (OPC). The three arms are: 1) 3As+R (Standard Care): Ask (screen all patients), Advise (advice to quit), Assist (brief counseling), and Refer to Viet Nam’s national Quitline; 2) SC+Counsel: Counsel= 6-session onsite cessation counseling intervention tailored to PLWH and delivered by trained, onsite clinic staff; and 3) SC+Counsel+N: N= 4 weeks of nicotine replacement therapy. Patients (n=672) will be recruited at 14 HIV OPCs in Viet Nam and randomized into one of the three study arms. The study will compare the 3As+R (standard care (SC) with Quitline referral) to SC plus two tobacco treatment model e...