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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 2021

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 January 2020, the research team continued to perform quality control checks at all study sites. These supervision checks are used to address challenges raised at each of the sites, such as difficulty of enrolling participants and transfer of health care workers serving as enumerators for the study. Qualitative data was collected from nine facilities in all the regions: Kampala, Eastern region, Western region, and Northern region. The analysis was completed and two manuscripts are in draft form for submission. The team continues to work actively with the Ministry of Health departments responsible for TB and tobacco cessation to ensure these individuals are aware of the progress and achievements the PEER project has made. All four students recruited for the project finished their dissertations. Due to the transfer and redeployment of health care workers serving as enumerators, those facilities that did not have health workers had new health workers recruited. The training took place in December 2019 and the team hopes that the health care workers will rejuvenate the recruitment process.

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