Background South Africa is among the seven highest tuberculosis (TB) burden countries. Harmful lifestyle behaviours, such as smoking and alcohol, and poor adherence to medication can affect clinical outcomes. Modification of these behaviours is likely to improve TB treatment outcomes and has proven possible using motivational interviewing (MI) techniques or use of short message service (SMS) text messaging. There have been no studies assessing the effect of combined MI and SMS interventions on multiple lifestyle factors and TB treatment outcomes. Methods This is a prospective, multicentre, two-arm individual randomised controlled trial looking at the effectiveness and cost-effectiveness of a complex behavioural intervention (the ProLife programme) on improving TB and lifestyle-related outcomes in three provinces of South Africa. The ProLife programme consists of an MI counselling strategy, delivered by lay health workers, augmented with subsequent SMS. We aim to recruit 696 adult participants (aged 18 years and over) with drug-sensitive pulmonary TB who are current smokers and/or report harmful or hazardous alcohol use. Patients will be consecutively enrolled at 27 clinics in three different health districts in South Africa. Participants randomised individually to the intervention arm will receive three MI counselling sessions one month apart. Each MI session will be followed by twice-weekly SMS messages targeting treatment adherence, alcohol use and tobacco smoking, as appropriate. We will assess the effect on TB treatment success, using standard World Health Organization (WHO) treatment outcome definitions (primary outcome), as well as on a range of secondary outcomes including smoking cessation, reduction in alcohol use, and TB medication and anti-retroviral therapy adherence. Secondary outcomes will be measured at the three-month and six-month follow-ups. Discussion This trial aligns with the WHO agenda of integrating TB care with the care for chronic diseases of lifestyle, such as provision of smoking cessation treatments, and with the use of digital technologies. If the ProLife programme is found to be effective and cost-effective, the programme could have significant implications for TB treatment globally and could be successfully implemented in a wide range of TB treatment settings. Trial registration ISRCTN Registry, ISRCTN62728852 . Registered on 13 April 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3551-9) contains supplementary material, which is available to authorized users.

ObjectiveTo investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking.DesignMulticentre, individual, randomised controlled trial where participants were assigned (1:1) to the ProLife intervention or usual care.Setting27 primary care clinics in South Africa.Participants574 adults starting treatment for drug-sensitive pulmonary TB who smoked tobacco or reported harmful/hazardous alcohol use.InterventionsThe intervention, delivered by lay health workers (LHWs), consisted of three brief motivational interviewing (MI) sessions, augmented with short message service (SMS) messages, targeting medication adherence, alcohol use and tobacco smoking.Outcome measuresThe primary outcome was successful versus unsuccessful TB treatment at 6–9 months, from TB records. Secondary outcomes were biochemically confirmed sustained smoking cessation, reduction in the Alcohol Use Disorder Identification Test (AUDIT) score, improved TB and antiretroviral therapy (ART) adherence and ART initiation, each measured at 3 and 6 months by questionnaires; and cure rates in patients who had bacteriology-confirmed TB at baseline, from TB records.ResultsBetween 15 November 2018 and 31 August 2019, 574 participants were randomised to receive either the intervention (n=283) or usual care (n=291). TB treatment success rates did not differ significantly between intervention (67.8%) and control (70.1%; OR 0.9, 95% CI 0.64% to 1.27%). There was no evidence of an effect at 3 and 6 months, respectively, on continuous smoking abstinence (OR 0.65, 95% CI 0.37 to 1.14; OR 0.76, 95% CI 0.35 to 1.63), TB medication adherence (OR 1.22, 95% CI 0.52 to 2.87; OR 0.89, 95% CI 0.26 to 3.07), taking ART (OR 0.79, 95% CI 0.38 to 1.65; OR 2.05, 95% CI 0.80 to 5.27) or AUDIT scores (mean score difference 0.55, 95% CI −1.01 to 2.11; −0.04, 95% CI −2.0 to 1.91) and adjusting for baseline values. Cure rates were not significantly higher (OR 1.16, 95% CI 0.83 to 1.63).ConclusionsSimultaneous targeting of multiple health risk behaviours with MI and SMS using LHWs may not be an effective approach to improve TB outcomes.Trial registration numberISRCTN62728852.

The achievement of global and national health goals requires a health workforce that is sufficient and trained. Despite considerable steps in medical education, the teaching of management, health economics and research skills for medical doctors are often neglected in medical curricula. This study explored the opinions and experiences of medical doctors and academic educationalists on the inclusion of management, health economics and research in the medical curriculum. A qualitative study was undertaken at four medical schools in Southern Africa (February to April 2021). The study population was medical doctors and academic educationalists. Semi-structured interviews with purposively sampled participants were conducted. All interviews were recorded and professionally transcribed. Constructivist grounded theory guided the analysis with the use of ATLAS.ti version 9.1.7.0 software. In total, 21 academic educationalists and 28 medical doctors were interviewed. In the first theme We know, participants acknowledged the constraints of medical schools but were adamant that management needed to be taught intentionally and explicitly. The teaching and assessment of management and health economics was generally reported to be ad hoc and unstructured. There was a desire that graduates are able to use, but not necessarily do research. In comparison to management and research, support for the inclusion of health economics in the curriculum was insignificant. Under We hope, educationalists hoped that the formal clinical teaching will somehow instil values and best practices of management and that medical doctors would become health advocates. Most participants wished that research training could be optimised, especially in relation to the duration of allocated time; the timing in the curriculum and the learning outcomes. Despite acknowledgement that management and research are topics that need to be taught, educationalists appeared to rely on chance to teach and assess management in particular. These qualitative study findings will be used to develop a discrete choice experiment to inform optimal curricula design.

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BackgroundEducation and training of undergraduate health science students in public health are insufficient in many parts of the world. This lack is a risk as early interest in specialist training options is a predictor of future training choices. A special interest group (SIG) is one mechanism to engage students, increase awareness and generate interest in public health. The purpose of this case study was to create and study such a group at an African university.Case presentationAn action research study design was used to create and study the SIG. All interested students were invited to participate in the SIG and in the data collection procedures. Data were collected via paper-based and online questionnaires. Records of activities were documented, and a reflective diary was kept by the researcher. Seven SIG meetings were held which were less than planned—some sessions were cancelled due to general student unrest. The composition of the SIG fluctuated, but the core group of 16 students consisted of 12 females (75%) and 4 males (25%). Despite faculty-wide marketing, all the participants were medical students. The most successful marketing strategy was done by two lecturers. A total of 12 participants’ motivation (75%) was to learn more about public health. Despite the range of participants being over 4-year groups with varying schedules and commitments, a convenient day and meeting time were identified. The social capital of lecturers was harnessed to invite external guest lecturers as planned field trips proved impractical. At the mid-year point, six students (38%) thought that they would consider public health as a career choice. A decision was made to recruit new members via a seminar, and 37 possible new members were identified in the process.ConclusionsA SIG appears to be an effective strategy to increase public health interest among students. This finding is key in settings with particular health workforce shortages and high burdens of disease. A foundation phase with high levels of academic support by those already qualified is needed to allow student leadership to emerge. Despite the modified and reduced number of sessions, the SIG was still successful in increasing awareness about public health and possible career choices: both positive consequences of engaging with students within a SIG.