Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised controlled trial of the ProLife programme in South Africa

Abstract

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.

Gender and Context Matter: Behavioral and Structural Interventions for People Who Use Alcohol and Other Drugs in Africa

“…These interventions enrolled women who were pregnant, men, adolescents, individuals at increased risk for or living with HIV, employees at a safety and security company, members of a market traders association, parents or caretakers of adolescents, individuals receiving treatment for pulmonary TB, and adults from prioritized communities. Intervention types included home visits [ 90 ], brief and motivational interventions [ 91 , 92 , 93 ], six 75 min intervention group sessions [ 94 ], a school-based intervention [ 95 ], four 3-h intervention sessions [ 96 ], financial incentives [ 97 ], a parenting skills intervention [ 98 ], a lifestyle behavioral intervention [ 99 ], a clinic-based intervention [ 100 ], a training workplace-based intervention [ 101 ], and a community-based structural–behavioral intervention [ 102 ]. Study samples ranged from 185 to 11,448 participants.…”

“…Within this review, we also recognize sample size limitations that reduce power and the ability to demonstrate significant outcomes over longer follow-up periods. Notably, one project faced a reduced follow-up sample because of COVID-19 [ 93 ].…”

“…One intervention focused on men used same-gender community facilitators to discuss HIV risk-reduction and condom use, and increase HIV/STI knowledge [94]; another intervention promoted healthy masculinity and reducing violence among rural and peri-urban men [96]; and another intervention focused on men and evaluated the effectiveness of financial incentives in reducing spending on alcohol, gambling, and transactional sex [97]. [93] South Africa: 574 adults beginning treatment for drug-sensitive pulmonary TB Lay health workers delivering three MI sessions along with SMS messages to bolster intervention content EtOH, TB ProLife Intervention: Participants created plans to address alcohol and tobacco use and TB adherence followed by 10 SMS messages supporting TB treatment adherence Reductions in AUDIT scores at follow-up but no significant intervention effect…”

Nudging Interventions on Alcohol and Tobacco Consumption in Adults: A Scoping Review of the Literature

“…Of the total number, after the two rounds of screening (i.e., titles, abstracts, and full texts), 3031 studies were screened out due to an incompatibility with the inclusion criteria (e.g., wrong intervention, no outcome measurement, wrong study design, or publication type). As a result, 20 studies [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62] were included in the review. The full selection process is shown in Figure 1.…”

“…Of the 20 studies in the final review, 10 (50%) [49,50,53,54,[56][57][58][60][61][62] were conducted in the USA, 6 (30%) in the UK [45,46,48,52,55,59], 2 (10%) in South Africa [44,51], and 2 in Bangladesh (10%) [43,47]. 55% of the included studies focused their interventions on smoking cessation [43,45,47,50,54,[56][57][58][59]61,62], 35% on alcohol drinking cessation [46,48,49,52,53,55,60], and 10% targeted both risk factors [44,51]. Table S1 in the Supplementary Materials provides further details on the characteristics of the studies.…”