TB & Tobacco Consortium: the evidence behind the intervention

The Tuberculosis (TB) & Tobacco Consortium consists of partners in Bangladesh (the ARK Foundation), Nepal (HERD International), Pakistan (the National TB Programme and The Initiative), the University of Leeds (Dr Helen Elsey), led by the University of York (Dr Kamran Siddiqi). The Consortium, with EU H2020 funding, has developed and studied the implementation of a brief behaviour support intervention to support people with tuberculosis to quit tobacco use. The intervention has been used as part of a hybrid randomised control trial which tests the cost-effectiveness of the cessation drug cytisine.

More details about the TB & Tobacco Consortium hybrid trial can be found here (link to Uni of York website).

The trial protocol can be found at:

Dogar O, Barua D, Boeckmann M, Elsey H, Fatima R, Gabe R, Huque R, Keding A, Khan A, Kotz D, Kralikova E, Newell JN, Nohavova I, Parrott S, Readshaw A, Renwick L, Sheikh A, Siddiqi K, and on behalf of the TB and Tobacco project consortium. The safety, effectiveness and cost‐effectiveness of cytisine in achieving six‐month continuous smoking abstinence in tuberculosis patients—protocol for a double‐blind, placebo‐controlled randomized trial. Addiction, April 2018. doi: 10.1111/add.14242

The protocol for the process evaluation can be found at:

Boeckmann M, Nohavova I, Dogar O on behalf of the TB & Tobacco Project Consortium, et al Protocol for the mixed-methods process and context evaluation of the TB & Tobacco randomised controlled trial in Bangladesh and Pakistan: a hybrid effectiveness–implementation study BMJ Open 2018;8. doi: 10.1136/bmjopen-2017-019878

The TB & Tobacco Consortium builds on previous work to develop, test the effectiveness and study the implementation of behaviour support with national TB programmes in South Asia, which showed that behaviour support provided by TB health professionals (DOTS facilitators) achieved 41% quit rates among people with TB measured biochemically six months after the intervention.

Siddiqi K, Khan A, Ahmad M, Kanaan M, Dogar O, Newell J, Thompson H. Action to Stop Smoking In Suspected Tuberculosis (ASSIST) in Pakistan: a randomised, controlled trial. Annals of Internal Medicine 2013;158:667-675. doi: 10.7326/0003-4819-158-9-201305070-00006

People diagnosed with TB were found to be significantly more likely to quit than patients with other lung diseases, making TB diagnosis a ‘teachable moment’ which health professionals can use to help their patients quit.

Elsey H, Dogar O, Ahluwalia J, Siddiqi K. Predictors of cessation in smokers suspected of TB: secondary analysis of data from a cluster randomized controlled trial. Drug and Alcohol Dependence 2015;155:128-133. doi: 10.1016/j.drugalcdep.2015.08.002

Implementing tobacco cessation within routine TB services in low income countries presents challenges and opportunities, which are identified in the following papers which describe lessons on implementation.

Elsey H, Khanal S, Manandhar S, Sah D, Baral SC, Siddiqi K, Newell JN. Understanding Implementation and Feasibility of Tobacco Cessation in Routine Primary Care in Nepal: mixed methods study. Implementation Science 2016;11:104. doi: 10.1186/s13012-016-0466-7

Dogar O, Elsey H, Khanal S, Siddiqi K. (2015) Challenges of Integrating Tobacco Cessation Interventions in TB Programmes: Case Studies from Nepal and Pakistan. Journal of Smoking Cessation 2016;11:108-115. doi: 10.1017/jsc.2015.20