One in four tuberculosis (TB) deaths in South Africa could be prevented if tobacco smoking were eliminated and 10% of the global burden of TB is attributable to alcohol use. Both smoking and harmful alcohol use in TB patients have been associated with poor drug adherence and low treatment success. Furthermore, if TB patients are also co-infected with HIV, non-initiation of antiretroviral treatment (ART) or poor adherence to ART increases the risk of adverse effects and death. Alcohol and/or tobacco smoking are common among TB patients in South Africa. Moreover these lifestyle behaviours occur more often among men who are at greater risk of late care seeking for HIV. Therefore addressing these lifestyle behavioural risk factors in an integrated way could improve TB treatment outcomes. Such an intervention may also impact on the transmission of TB, as family members of smokers, children in particular, are more likely to acquire TB than those of non-smokers. The proposed intervention may also help improve provider-patient communication, which has also been associated with poor treatment adherence.
The project aims to develop a complex behavioural intervention - the PROLIFE care model, comprised of a brief motivational interviewing (MI) counselling strategy augmented with subsequent text messaging. To be delivered in multiple brief sessions, the MI intervention will target several areas, as appropriate:
The PROLIFE model, building on an earlier successful trial of MI for smoking cessation in TB patients, will be evaluated through a pragmatic, prospective, two-arm cluster randomised control trial (cRCT) in primary health care clinics (PHC) located in high TB burden communities in three provinces in South Africa. The project aims to achieve the following: