Smoking cessation outcomes in TB clinics

South Africa has the third highest number of tuberculosis (TB) cases in the world, according to the World Health Organization. Tuberculosis patients who smoke risk adverse TB outcomes and other long-term health effects of smoking.

A study in the journal Addiction sought to determine how well brief motivational interviewing (MI) by lay health-care workers (LHCWs) would assist TB patients in their effort to quit smoking. Since both TB and smoking affect the lungs, a diagnosis of TB offers an ideal learning opportunity.

Method

The study took place at six primary care tuberculosis clinics in the South African township of Soshanguve (in the city of Tshwane Metropolitan Municipality), an urban township with a large number of TB patients.

Lay health-care workers assist with administrative and counselling tasks at the primary care facilities. For this study, eight LHCWs were trained as data collectors and tobacco cessation counsellors.

A sample size of a minimum of 400 was estimated for this multi-centre, two-group, parallel, individualized randomized control trial (RCT). The intervention group included 205 participants and the control group included 204 (21 participants died during follow-up).

All study participants received the following message from the TB clinic nurse:

“Tobacco use is extremely harmful for your health. If you stop smoking now, your TB will heal better and you will have a lower risk of getting TB again in the future. You will also reduce your risk of hearth disease and cancer and protect your children against TB. As a professional nurse, I advise you to stop using tobacco in the interests of your health.”

All of the patients also received a smoking cessation booklet supplied by the National Council against Smoking of South Africa. (Pharmacotherapy was not offered to smokers, as smoking cessation medication is expensive and not available in public primary care clinics in South Africa.)

Outcomes

The self-reported six-month sustained abstinence was more than twice as high in the intervention group as in the control group (21.5% for the intervention group; 9.3% for the control group).

At six months, 165 participants underwent exhaled CO testing. This biochemically verified six-month sustained abstinence was higher in the intervention group – 28.9 % vs. 13.3% in the control group.

Conclusions

The results of this study show that brief motivational interviewing by LHCWs was effective in assisting TB patients to quit tobacco smoking. Using brief MI in an effort to promote smoking cessation in TB patients in South Africa approximately doubled the sustained smoking abstinence for at least six months compared with using brief advice alone.

Another important finding is that smoking cessation services can be effectively

“Efficacy of brief motivational interviewing on smoking cessation at tuberculosis clinics in Tshwane, South Africa: a randomized controlled trial”, Addiction 2014, by Goedele M. C. Louwagie (School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa),  Kolawole S. Okuyemi (Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA),  Olalekan A. Ayo-Yusuf (School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, South Africa, Dean/Director’s Office, School of Oral Health Sciences, Faculty of Health Sciences, University of Limpopo, Medunsa Campus, South Africa), and Regional Director of Global Bridges in the AFRO Region