The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes

Abstract

BackgroundThere is substantial evidence to support the association between tuberculosis (TB) and tobacco smoking and that the smoking-related immunological abnormalities in TB are reversible within six weeks of cessation. Therefore, connecting TB and tobacco cessation interventions may produce significant benefits and positively impact TB treatment outcomes. However, no study has extensively documented the evidence of benefits of such integration. SCIDOTS Project is a study from the context of a developing nation aimed to determine this.MethodsAn integrated TB-tobacco intervention was provided by trained TB directly observed therapy short-course (DOTS) providers at five chest clinics in Malaysia. The study was a prospective non-randomized controlled intervention using quasi-experimental design. Using Transtheoretical Model approach, 120 eligible participants who were current smokers at the time of TB diagnosis were assigned to either of two treatment groups: conventional TB DOTS plus smoking cessation intervention (integrated intervention or SCIDOTS group) or conventional TB DOTS alone (comparison or DOTS group). At baseline, newly diagnosed TB patients considering quitting smoking within the next 30 days were placed in the integrated intervention group, while those who were contemplating quitting were assigned to the comparison group. Eleven sessions of individualized cognitive behavioral therapy with or without nicotine replacement therapy were provided to each participant in the integrated intervention group. The impacts of the novel approach on biochemically validated smoking cessation and TB treatment outcomes were measured periodically as appropriate.ResultsA linear effect on both 7-day point prevalence abstinence and continuous abstinence was observed over time in the intervention group. At the end of 6 months, patients who received the integrated intervention had significantly higher rate of success in quitting smoking when compared with those who received the conventional TB treatment alone (77.5% vs. 8.7%; p < 0.001). Furthermore, at the end of TB treatment (6 months or later), there were significantly higher rates of treatment default (15.2% vs. 2.5%; p = 0.019) and treatment failure (6.5% vs. 0%; p = 0.019) in the DOTS group than in the SCIDOTS group.ConclusionThis study provides evidence that connecting TB-tobacco treatment strategy is significant among TB patients who are smokers. The findings suggest that the integrated approach may be beneficial and confer advantages on short-term outcomes and possibly on future lung health of TB patients who quit smoking. This study may have important implications on health policy and clinical practice related to TB management among tobacco users.

Predictors of cessation in smokers suspected of TB: Secondary analysis of data from a cluster randomized controlled trial

“…The stigma associated with TB is well documented, and this often leads to changes in conceptions of self and social role (Christodoulou, 2011). This study reinforces the message from previous studies of the effectiveness of targeting TB patients in smoking cessation programs (Awaisu et al, 2011;El-Sony et al, 2007;Ng et al, 2008). McBride et al, 2003) characteristics of teachable moments may also explain why those with a respiratory condition other than TB were not so successful in their cessation.…”

“…This offers opportunities for teachable moments to provide cessation to patients suspected of TB who also smoke (Ng et al, 2008). For example, DOTS facilitators can be trained to provide advice and counseling to patients with suspected TB (Awaisu et al, 2011;El-Sony et al, 2007) This paper analyses data from the ASSIST trial Siddiqi et al, 2010) which tested a behavioral support session with (BSS+) and without bupropion (BSS), delivered by DOTS facilitators to provide smoking cessation support to patients with suspected TB. Both treatment conditions led to an eight-to nine-fold increase in continuous smoking abstinence compared to the usual care; more details can be found in the published protocol and findings of this trial Siddiqi et al, 2010).…”

South African tobacco smoking cessation clinical practice guideline

“…[6,68] There are some data to show that integrating smoking cessation efforts (support plus NRT) with TB treatment is feasible, [69] improves quit rates (77% v. 8.7%, respectively) and completion of TB treatment (97.5% v. 84.8%, respectively). [70] It is unclear, however, whether stopping smoking during TB therapy will reduce the excess mortality associated with smoking and TB, [71] nor are there any efficacy data available on whether using bupropion or varenicline with concomitant anti-TB therapy may be of benefit. Smoking cessation should, however, be encouraged in all TB patients and appropriate support provided.…”

High quit rate among smokers with tuberculosis in a modified smoking cessation programme in Dhaka, Bangladesh

“…Previous studies have shown that the introduction of tobacco cessation services is feasible and results in smoking quit rates of up to 77%, associated with substantial improvements in quality of life and better TB treatment outcomes. 2 The World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) thus recommend the promotion of smoking cessation as an integral part of TB patient care. 3 In Bangladesh, TB is a major health problem and tobacco use is also common, with 50% of men and 2% of women reporting current smoking.…”