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Multiple randomized controlled trials have tested cessation treatments in this population, but little is known about factors that mediate successful quitting. We conducted a randomized, placebo-controlled 2\u2009\u00d7\u20092 factorial design trial of a behavioral intervention (Positively Smoke Free [PSF] one-on-one counseling) vs. brief advice to quit\u2009\u00b1\u2009bupropion vs. placebo in PWH who smoked cigarettes in Nairobi, Kenya. Abstinence from cigarettes was assessed by self-report and exhaled carbon monoxide (ECO). We conducted pre-planned analyses of putative mediators of the effects of bupropion (i.e. craving, withdrawal, negative affect) and of PSF counseling (i.e. abstinence self-efficacy, decisional balance, and loneliness) at 12-weeks on biochemically-confirmed abstinence at 36-weeks. 269 participants were included in the final analytic cohort (mean age\u2009=\u200942.7 years, 70.3% male, smoking a mean of 10.6 cigarettes per day). The biochemically verified abstinence rate at 36-weeks was 24.2%. PSF counseling increased abstinence self-efficacy and reduced loneliness significantly more than brief advice to quit at 12-weeks. Mediation analyses suggested a mediating effect of change in self-efficacy at 12-weeks in the relationship of PSF to abstinence at 36-weeks. None of the putative mediators demonstrated a significant mediation effect of bupropion on quitting. These results indicate that self-efficacy was one mechanism through which PSF counseling, but not bupropion, increased smoking abstinence among PWH who smoked cigarettes in Nairobi, Kenya.<\/jats:p>\n                  <jats:p>Trial Registration:\u00a0NCT02460900<\/jats:p>","DOI":"10.1007\/s10461-025-04968-5","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T15:00:49Z","timestamp":1765378849000},"page":"1498-1505","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Mediation Effects of Biobehavioral Factors in a Trial of Pharmacotherapy and Intensive Cessation Counseling for People with HIV Who Smoke Cigarettes in Nairobi, Kenya"],"prefix":"10.1007","volume":"30","clinical-trial-number":[{"clinical-trial-number":"nct02460900","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Angela A.","family":"Omanya","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0702-7789","authenticated-orcid":false,"given":"Jonathan","family":"Shuter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emily","family":"Koech","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sylvia","family":"Ojoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wendy","family":"Potts","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lan","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher W.","family":"Kahler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seth S.","family":"Himelhoch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,10]]},"reference":[{"issue":"8","key":"4968_CR1","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1093\/ntr\/ntaa277","volume":"4","author":"T Asfar","year":"2021","unstructured":"Asfar T, Perez A, Shipman P, et al. 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