Tobacco Cessation within TB programmes: A ‘real world’ solution for countries with dual burden of disease

Project Progress :

100 % progress so far

Started Date:January 01 2016 Completed Date:December 30 2019

Tobacco Cessation within TB programmes: A ‘real world’ solution for countries with dual burden of disease

Categories :

Randomized Control Trial (RCT)



Tobacco smoking almost doubles the risk of acquiring TB infection. Moreover, the odds of developing active TB disease for smokers are twice those of non-smokers. Smoking also affects the dynamics of disease progression in individuals with latent TB; a strong association of active disease with smoking is seen among tuberculin skin test (TST) positive individuals, suggesting that smoking induces progression or reactivation in those infected with TB.  Tobacco smoking also has profound effects on TB treatment outcomes. Smoking increases the risk of dying from TB, after adjusting for socioeconomic status. Smoking also leads to faster and more severe progression of pulmonary TB disease, with more cavity lesions and greater likelihood of hospitalization. Smoking increases the length of treatment needed to convert sputum culture from positive to negative in TB patients. Default or poor drug compliance among TB patients has also been associated with smoking. 

The research is centered on three countries that have high incidence of tobacco use and high prevalence of TB, namely Bangladesh, Nepal and Pakistan.  In Nepal, HERD International is implementing this study to reduce the burden of tobacco-related lung diseases. Our approach is to integrate tobacco cessation strategies into TB control programmes, which consists of different work packages/activities.

Goals and objectives of the program

The major objectives of this program is to reduce the burden of lung diseases in low-and middle-income countries (LMIC) by integrating inexpensive tobacco cessation strategies of proven efficacy (behavioral and pharmacological) into tuberculosis (TB) control programs.

Implementation activities

The program has been divided into different work packages for the ease of the implementation. HERD International has conducted following activities:

Work packages


Work package 1.

Development and feasibility

  • Selection of program implementation site
  • Preparation of IEC materials
  • Series of workshop with DOTS facilitators and stakeholders
  • Expert panel group meeting
  • Feedback collection from key personnel
  • Finalization of IEC materials for behavioral support
  • Training to DOTS facilitators
  • Preparation of health worker’s guidelines
  • Implementation of behavioral support activity in DOTS center’s
  • Regular monitoring and follow up to the center’s

Work package 2.

Process evaluation

  • Health workers interview
  • Observation of health facilities
  • Interview with patients

Work package 3.

 Context  evaluation

  • Data collection from heath workers interview

Work package 4.

 Scale up and sustainability

  • Data analysis from DOTS centers
  • Revision of IEC materials as per he learning and experiences from the field through workshop with DOTS facilitators
  • Preparation of videos from health workers ongoing
  • Preparation of desk guide

Project Focal person

This project's focal person is Mr. Prabin Shrestha