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An intervention to stop smoking among patients suspected of TB - evaluation of an integrated approach

DOI: 10.1186/1471-2458-10-160

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We aim to develop and trial a complex intervention to reduce tobacco dependence among TB suspects based on the WHO 'five steps to quit' model. This model relies on assessing personal motivation to quit tobacco use and uses it as the basis for assessing suitability for the different therapeutic options for tobacco dependence.We will use the Medical Research Council framework approach for evaluating complex interventions to: (a) design an evidence-based treatment package (likely to consist of training materials for health professionals and education tools for patients); (b) pilot the package to determine the delivery modalities in TB programme (c) assess the incremental cost-effectiveness of the package compared to usual care using a cluster RCT design; (d) to determine barriers and drivers to the provision of treatment of tobacco dependence within TB programmes; and (e) support long term implementation. The main outcomes to assess the effectiveness would be point abstinence at 4 weeks and continuous abstinence up to 6 months.This work will be carried out in Pakistan and is expected to have relevance for other low and middle income countries with high tobacco use and TB incidence. This will enhance our knowledge of the cost-effectiveness of treating tobacco dependence in patients suspected of TB.Trial Registration Number: ISRCTN08829879Eight out of every ten smokers live in low- and middle-income countries[1]. In several of these countries, tobacco use is on the increase. Consequently, 70% of the projected mortality secondary to tobacco use is likely to be borne by low- and middle-income countries[1]. In addition, people die at an earlier age in such countries, causing the loss of 20-25 years of productive life[2]. Cost of cigarettes is relatively high in low- and middle-income countries compared to food and other essential commodities, resulting sometimes in their substitution. Therefore, tobacco use puts enormous burdens on countries' already ailing economies and co

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