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Background

Tuberculosis and tobacco use are two formidable public health concerns and independently pose considerable threats to global health. In 2011, nearly 6 million people died from tobacco use globally and tobacco use is responsible for 16% and 7% of annual deaths among men and women, respectively. Smoking is an established risk factor for Mycobacterium Tuberculosis, developing TB, exacerbating TB, and dying from TB. Compared with never-smokers, smokers have twice the risk of Mycobacterium tuberculosis infection. Globally, more than 20% of TB cases are attributable to smoking; hence, the critical need to reduce TB prevalence through tobacco cessation.

Goals and objectives

The goal of the project is to use mHealth solutions to integrate tobacco control into TB programmes to improve TB treatment outcomes in Uganda. The primary objective is to support TB patients to quit tobacco use. The secondary objectives are: a) To train health workers on mHealth solutions for TB-Tobacco integration; b) To assess the period that participants take to quit tobacco use; c) To support TB patients to adhere to TB treatment

Methods

The study is an experimental prospective cohort design involving TB patients who are current tobacco users. The study will target 634 TB patients; 317 in the intervention arm and 317 in the control arm randomized at individual level using block randomization at the SMS provider. Participants will be supported with text messages on tobacco cessation and TB treatment adherence for 4 months. The primary outcome is tobacco use cessation. Secondary outcomes include improved knowledge on tobacco cessation among healthcare workers, time to quit tobacco use and TB adherence. The study will take place in 27 health facilities in the country including the 13 regional referral hospitals, other 6 general hospitals in the country and the 8 health facilities in Kampala City where TB treatment if offered. Analysis for the primary outcome which is smoking cessation will be done by comparing non-intervention and intervention participants. The study will be submitted for approval to the Makerere University School of Public Health IRB and Uganda National Council for Science and Technology.

Project Implementation 

The project will be implemented through a partnership arrangement led by Makerere University School of Public Health-Centre for Tobacco Control in Africa (MakSPH-CTCA) in collaboration with Ministry of Health Uganda-TB and Tobacco Control Program; East Tennessee State University and WHO.