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Integrating Smoking Cessation Interventions in Routine TB Care & Treatment

Challenge

Tobacco smoking significantly increases the risk of  TB infection, disease and mortality. The World Health Organization estimates that greater than 20% of the global burden of TB may be attributable to smoking.

In low-income countries like Pakistan, where TB is widespread and tobacco use is high, the integration of smoking cessation interventions into regular TB treatment is highly recommended. The deleterious effects of tobacco use by TB patients are not well known to health care providers, and are thereby not addressed during routine medical care and TB treatment.

In order to provide effective treatment and care, there lies a need to conduct research to assess the effectiveness of smoking cessation strategies on TB patients and evaluate whether negative outcomes of TB are reduced by smoking cessation.

Our Approach

IRD Pakistan is conducting a Randomized Control Trial (RCT) to gauge the effectiveness of behavioral smoking cessation strategies for male Pulmonary TB patients who are current smokers or recent smokers. Further, the trial aims to determine whether smoking cessation reduces negative TB outcomes, including time to smear conversion, treatment failure, relapse and death.

The clinical trial is being carried out at 4 public and private hospitals in Karachi, Pakistan with an enrollment of 350 patients. The trial has two arms to assess the impact of the behavioral intervention 1) An intervention arm in which patients are receiving standard care with enhanced cessation advice and support, both at and outside the TB clinic for the complete duration of the treatment – such as in-person counseling tailored to the needs and circumstances of the patient 2) A control arm in which patients are receiving standard cessation advice and support at the start of their treatment program.

 Expected Impact

IRD is aiming to use the findings of this trial to launch a full-fledged program that will integrate behavioral smoking cessation interventions at TB treatment and care programs at hospitals and clinics across Pakistan.