Feasibility study of a smoking cessation intervention in Directly Observed Therapy Short-Course tuberculosis treatment clinics in Rio de Janeiro, Brazil

Abstract

A pilot feasibility study was conducted to determine whether Directly Observed Therapy Short-Course (DOTS) workers could be trained to deliver smoking cessation counseling and referral interventions, identify potential barriers to a full-scale randomized controlled trial on the effectiveness of integrated smoking cessation in DOTS, and determine whether tuberculosis (TB) patients who smoke would agree to participate in such a program. DOTS providers in two Rio de Janeiro primary health clinics received 1-day training in cessation counseling. They completed pre- and post-training surveys and participated in post-program focus groups. Patients were surveyed 3 months after program completion, and semiquantitative urine assays for cotinine were used to confirm cessation. Providers' mean self-efficacy scores for cessation counseling improved significantly (advise to quit, assess readiness, assist with quitting, and arrange follow-up) from scores (on a scale of 1-5) of 2-3 pre-training to 3-4 post-training (P < 0.05), with only ability to change motivation not significant. Providers' knowledge about cessation (withdrawal, nicotine replacement therapy, precontemplation) was low before training and did not improve after training (P > 0.1 for all comparisons). Implementation of a smoking cessation intervention by DOTS providers in TB clinics in Brazil is feasible. Randomized controlled trials to test intervention effectiveness in reducing TB-related morbidity must include cross-training for tobacco control and TB providers. Smoking cessation in DOTS programs may be important in reducing the global burden of TB, improving the health of TB patients, and reducing TB transmission in households.

Statement on smoking cessation in COPD and other pulmonary diseases and in smokers with comorbidities who find it difficult to quit

“…Benefits of quitting smoking and quit strategies in patients with TB Training TB healthcare workers using DOTS (directly observed treatment, short-course) in Rio de Janeiro, Brazil to deliver smoking cessation for 1 day improved their self-rated efficacy but the effects on smoking rates were not reported [147].…”

South African tobacco smoking cessation clinical practice guideline

“…[65][66][67] In SA, with the added risk of HIV, the importance of smoking cessation to reduce the risk of TB, HIV-related diseases and COPD is unquestionable. [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.…”

Tuberculosis: renewed challenge in Brazil

“…This scenario may be result from the fragile interaction between researchers and TB and HIV managers, who prioritize activities in TB, TB/HIV care, or surveillance activities, but not research. In addition, favorable results obtained through research carried out in high burden countries, such as Brazil, usually do not have long-term sustainability and are not incorporated into the routine of the health system [21][22][23][24] . Among the most widely used interventions recommended by the WHO, we cite the adoption of an early diagnosis of drug-resistant and drug-sensitive TB using new technologies (usually molecular tests) aiming to adopt appropriate treatment and taking measures to control TB infection in the community [25][26] .…”