Scaling up tobacco cessation within TB programmes: findings from a multi-country, mixed-methods implementation study

Area of Science:

• Public Health
• Health Systems Research
• Tobacco Control

Background:

• Brief behavioral support is effective for tuberculosis (TB) patients to quit smoking.
• Implementation and scale-up of cessation support were evaluated in Bangladesh, Nepal, and Pakistan.
• Strategies included brief interventions, training integration, routine record inclusion, and embedding research.

Purpose of the Study:

• To evaluate the implementation and scale-up of tobacco cessation support within TB programs.
• To understand facilitators of vertical (institutionalization) and horizontal (coverage) scale-up.
• To assess changes in health worker confidence and intervention delivery.

Main Methods:

• Mixed methods: observation, interviews, questionnaires, and routine data analysis.
• Assessed scale-up in 59 sites in Pakistan, 18 in Nepal, and 15 in Bangladesh.
• Surveyed 169 trained TB health workers; interviewed 44 stakeholders; conducted cost analysis.

Main Results:

• Health workers consistently asked TB patients about tobacco use and offered support.
• Integrated training increased health worker confidence by 17%.
• Health system changes (reporting, training) facilitated vertical scale-up; research embedding was crucial for horizontal scale-up.

Conclusions:

• System-level changes within TB programs can enable routine cessation support delivery.
• These strategies are inexpensive and can be institutionalized at scale with concerted efforts.
• Tobacco cessation integration is feasible and beneficial for TB patient outcomes.