Joint research tackles smoking and TB, a 'colliding epidemic'
Tuberculosis (TB) and tobacco-related lung disease kill millions around the world every year. What if programmes to stop one could target the other, too? An international initiative, including partners from Pakistan, Bangladesh and Nepal is doing just that, blending effective yet affordable tobacco cessation strategies with TB control programmes.
© glisic_albina #204435372, source: fotolia.com, 2018
Tobacco consumption and tuberculosis are colliding epidemics amplified by a chronic lack of information and facilities in many low- and middle- income countries (LMICs), according to experts in the EU-funded TB&Tobacco study.
The project focuses on reducing the burden of lung disease in three LMICs with noted high tobacco use and TB prevalence: Pakistan, Bangladesh and Nepal. It is helping newly diagnosed TB patients quit smoking using cost-effective strategies, including a new drug and targeted education. The logic is that TB patients are more likely to quit tobacco than healthy smokers.
In the absence of specialist infrastructure, we are piggybacking on existing approaches to tobacco cessation proven to work in countries like New Zealand, explains Anne Readshaw from University of Yorks Department of Health Sciences, which coordinates TB&Tobacco. We are trialling a smoking cessation drug called cytisine and tailoring behavioural support materials for patients involved in the trials, via clinics in the three test countries.
International contributions come from the National TB Programme and The Initiative in Pakistan, The ARK Foundation in Bangladesh, Heinrich-Heine University in Germany, the Universities of Edinburgh and Leeds in the UK, and the General University Hospital in the Czechia, as well as partners in Nepal.
First of its kind in LMICs
This is the first study of its kind to test cytisine on TB patients in LMICs. If successful, the drug combined with teachable moments augmented by the behavioural support materials offers huge potential public health benefits, according to the project team.
Preparations for the cytisine trial, which kicked off in mid-2017, included writing the trial protocol, obtaining ethics approvals, and preparing the patient data management strategy.
Approval for the trial in Nepal was held up, so the team decided to add extra patients in Bangladesh to compensate. The awareness-raising and behaviour-change campaign carried on as planned in Nepal and will be included in the findings.
With just weeks to go till the patient recruitment closed at the end of April 2018 the team reported more than 1 500 participants in Bangladesh and over 900 in Pakistan, which far exceeded the original target of 2 388 in total, even without Nepalese patients. Data from the trial are still being collated and will be subject to detailed analysis with lessons learned channelled back into TB programmes in the target countries.
This is pioneering research in Bangladesh, which is embedding tobacco cessation within the TB control programme to reduce the dual burden of disease. The policy-makers and service providers have been very supportive, providing technical guidance in implementing the study, notes Rumana Huque, principal investigator at the ARK Foundation. It gave us the opportunity to train therapists, programme managers and medical officers at sub-district level on the adverse impacts of tobacco consumption smoke and smokeless by developing their counselling skills and helping patients to quit. Patients found the counselling on tobacco cessation very helpful.
On message ...
The behavioural support materials flipbook, posters and leaflets use images to emphasise simple messages about the dangers of smoking, and how it makes TB worse. Pilot materials were tested on audiences in different countries and then adapted accordingly.
Key messages focus on essential aspects of TB disease, emphasising healthy living, including stopping smoking, to facilitate successful TB treatment. The materials have already been published in relevant local languages, with separate versions for male and female patients.
"Thanks to the collaborative efforts and combined expertise of our international research team, TB&Tobacco is producing some very useful results, confirms Readshaw, crediting the European Unions foresight to invest in global health initiatives, which ultimately affect every one of us.
Scale-up and implementation are extremely important aspects of the project and we will be focusing on these in the remaining months of TB&Tobacco, the project coordinator concludes.