PROJECT SUMMARY This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA- 23-052. Kenya is experiencing a syndemic of HIV and cancer that is aggravated by consumption of tobacco. Use of tobacco negatively impacts HIV treatment outcomes, increase the risks of cancer, and negatively impacts cancer treatment outcomes, and people living with HIV (PLHIV) have higher tobacco use rates than the general population. In Kenya, cancer is the third leading cause of death after infectious and cardiovascular diseases. From 2012 to 2018, the annual incidence of cancer increased from 37,000 to 47,887 new cases/year. During the same period, annual cancer mortality rose almost 16%, to 32,987 cancer-related deaths. There are significant socio-demographic disparities in tobacco, with people in the lower educational and economic strata having higher rates of tobacco use. Therefore, it is important to understand how household expenditures on tobacco impacts a household ability to access essential goods such as food and education. In this proposed administrative supplement, we will ask a sample of PLHIV who use tobacco about their expenditures on tobacco and other goods. The primary study (U01 CA261620-03) is a cluster randomized superiority trial assessing the impact of integrating tobacco use cessation into HIV care in 20 clinics in Kisumu County, Kenya. The primary study will compare 12-months biochemically verified point prevalence among tobacco users who received a brief intervention with tobacco users who received an intensive intervention. One of the primary study aims was to conduct in a cost-benefit analysis of the interventions but did not include the impact of the interventions on expenditures. Therefore, the Aims of this study are to: 1) Compare household spending patterns among PLHIV who use tobacco to household spending patterns among people in the general population who use tobacco in Kenya; 2) Compare the potential effect of a brief and an intensive tobacco cessation interventions on household expenditures among a sample of PLHIV who use tobacco, and 3) Model the potential effect of brief and intensive tobacco cessation interventions on household expenditures among PLHIV in Kenya. We will use items from the 2015- 2016 National Household Expenditure Survey to ask our sample (N=580) of PLHIV who use tobacco about their expenditures. We will then compare the results from this sample with the results of the national survey, which does not provide HIV-status of respondents. This will allow us to assess any financial burden related to tobacco expenditures among PLHIV. Further, we will be able to assess the impact of brief and intensive cessation interventions on household expenditures. This will provide data to model what the impact of scaling up a cessation intervention on national household expenditures on tobacco. The results of this project will inform allocation of resources for tobacco dependence tre...