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Cycle 5 (2016 Deadline)

mHealth for TB-Tobacco: An approach to reduce tobacco use among TB patients

PI: Elizeus Rutebemberwa (, Makerere University School of Public Health, Centre for Tobacco Control in Africa
U.S. Partner: Robert Pack, East Tennessee State University

Project Overview:

Tuberculosis (TB) and tobacco use are two formidable public health concerns and independently pose considerable threats to global health. In 2013, there were about 9 million new TB cases and 1.5 million TB-related deaths globally. In 2011, nearly 6 million people died from tobacco use globally. Tobacco use is responsible for 16% and 7% of annual deaths among men and women, respectively (WHO 2015). Beyond health implications, TB and tobacco use impose severe economic and social costs on families and communities, particularly for low- and middle-income countries (LMICs). Globally, more than 20% of TB cases are attributable to smoking, hence the critical need to reduce TB prevalence through smoking cessation. There is sparse information on how to incorporate tobacco control into TB programs in LMIC, particularly using mHealth solutions, even though the WHO Global TB program calls for an integrated approach toward TB-tobacco prevention and treatment. Given that non-communicable diseases (NCDs) now dominate healthcare in developed countries and most LMICs and that most LMICs are now facing a double burden of disease, there is an opportunity to broaden the mHealth agenda in developing countries to also look at NCDs. Previous studies into the use of mHealth technology for smoking cessation indicate significant potential in successful behavior change.

This project will provide policy and program recommendations to the TB program and the tobacco control programs in Uganda. The impact indicator is the improved health status of TB patients, which will be measured using the tobacco quit rates and TB treatment protocol adherence. Integrating tobacco cessation health education in treatment programs for TB patients improves the knowledge of TB patients, hence increasing their health-seeking behavior, an issue relevant to Uganda’s development objectives. It also improves organization and management of TB programs by giving TB patients access to tobacco cessation education and support when seeking TB treatment. This integration will include training of health workers and should result in improving the quality of health services. At the community level, the impact will be in giving patients access to the services even when they are not at the facility using the mHealth aspect. The project will recommend the use of the mCessation approach using SMS as a solution to providing information, following up with patients, and supporting them to quit tobacco use. The community impact indicators will be the proportion of messages responded to and the percentage of TB patients who changed behavior.

Summary of Recent Activities: 

During March – June 2017, a one-day inception meeting for Directors, Medical Superintendents, and In-charges of the implementing health facilities, was organized. It was held on the 25th of April 2017 in Kampala. The objective was to provide an overview of the research project and plan for start-up activities at the health facility level. The inception meeting was aimed at getting buy-in of the health facilities, hence creating a favorable environment for the research implementation, which was achieved. One of the core activities of this research project, is recruitment of TB patients who use tobacco at the health facility level and this will be done by heath workers in the TB Clinics. During the Inception Meeting, the Directors of the implementing health facilities identified a health worker from their TB clinics to participate in the study as a ‘Study Nurse’. A training for these health workers was conducted to prepare the Study Nurses for implementation. The objectives of the training were: orient health workers on TB-Tobacco integration; orient health workers on mHealth approach; increase health worker knowledge on tobacco; increase health worker knowledge on tobacco cessation; and orient health workers on implementation science research. The protocol was submitted to the Makerere University School of Public Health IRB and the team is addressing the boards comments. A four member Data Safety Monitoring Board (DSMB) was assembled. Identification was based on clinical expertise in the areas of TB, research specifically randomized controlled trials. On the board, a biostatistician and a community representative was included. Their main responsibility is to continually assess the scientific integrity and validity of the research study. They will be making recommendations to IRB. They will be meeting quarterly. The research team also completed online training for CITI certification.

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