A systematic review of the effectiveness of smoking cessation interventions among patients with tuberculosis in Low- and Middle-Income Countries (LMICs)

Abstract

Background: This systematic review aimed to evaluate the effectiveness of smoking cessation interventions in tuberculosis (TB) care programmes in low- and middle-income countries (LMICs). Of interest were facilitators and possible barriers to successful smoking cessation among TB patients. This review was motivated by the huge impact of smoking on TB treatment outcomes, and the possible advantages of addressing both health issues simultaneously in resource-restricted contexts.  

Methods: The review employed a systematic approach using the PICO framework. The review involved a comprehensive literature search of various databases for studies conducted in LMICs on the effectiveness of smoking cessation interventions for TB patients. The included studies were critically appraised using the Quality Assessment Tool for Quantitative Studies. 

Results: A total of 10 quantitative studies were extracted for synthesis of the findings. The findings showed three main types of interventions within the review: brief advice, behavioural counselling, and pharmacological. The review demonstrated some significant findings with regard to whether different kinds of smoking cessation practice were effective within the context of care provided for those people with TB. The greatest smoking cessation rates were from combined behavioural and pharmacological interventions ranging from 45% to 77% at 6-month follow-up. Quit rates of 20% to 40% were found for behavioural support alone, with brief advice interventions finding quit rates of 15% to 39%. Several facilitators for smoking cessation activities included having engaged health workers and integrating approaches into existing TB treatment programs. Barriers to quitting included strong nicotine addiction, social norms that support smoking, and limited resources.  

 Conclusion: These findings have important implications for individual health outcomes as well as public health goals more broadly and suggest that smoking cessation treatment is feasible and effective among TB patients. The review also indicates that areas for further exploration including longer-term follow-up of smoking cessation outcomes, cost effectiveness, and culturally tailored intervention development in various LMICs.