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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 Dates: February 2017 - January 2020

5-450 Rutebemberwa data collection
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: 

As of June 2019, the PI and research time continued to conduct quality control visits to the recruitment sites. Of the 23 total sites, 17 are active and are recruiting participants. These sites are distributed across the country. Since smoking in the community is not evenly spread in the country, some facilities may recruit more participants compared to other sites. Hospitals are also recruiting participants, but the main challenge was that many of the TB patients using tobacco do not have mobile phones. The qualitative data to generate views from the health workers about the integration of tobacco cessation into TB treatment are still being analysed by the team at Makerere University with support from the East Tennessee State University team. According to data collected by the project team, the regions of Karamoja and West Nile have the highest prevalence of tobacco use for individuals above the age of 10 years old at 24.5% and 14.5%, respectively. For comparison, the Uganda National Household Survey 2016/17, found the prevalence of tobacco use in Uganda for those aged above 10 years who had ever used or were currently using tobacco to be 5.4%.

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