Addressing tobacco smoking and drinking to improve TB treatment outcomes, in South Africa: a feasibility study of the ProLife program
Open accessAbstract
Alcohol and tobacco use may lead to negative treatment outcomes in tuberculosis (TB) patients, and even more so if they are HIV-infected. We developed and tested the feasibility of a complex behavioral intervention (ProLife) delivered by lay health workers (LHWs) to improve treatment outcomes in TB patients who smoke tobacco and/or drink alcohol, at nine clinics in South Africa. The intervention comprised three brief motivational interviewing (MI) sessions augmented with a short message service (SMS) program, targeting as appropriate: tobacco smoking, harmful or hazardous drinking and medication adherence. Patients received SMSs twice a week. We measured recruitment and retention rates and assessed fidelity to the MI technique (MI Treatment Integrity 4.1 tool). Finally, we explored LHWs’ and patients’ experiences through interviews and semi-structured questionnaires, respectively. We screened 137 TB patients and identified 14 smokers, 13 alcohol drinkers, and 18 patients with both behaviors. Participants’ mean age was 39.8 years, and 82.2% were men. The fidelity assessments pointed to the LHWs’ successful application of key MI skills, but failure to reach MI competency thresholds. Nevertheless, most patients rated the MI sessions as helpful, ascribed positive attributes to their counselors, and reported behavioral changes. SMSs were perceived as reinforcing but difficult language and technical delivery problems were identified as problems. The LHWs’ interview responses suggested that they (a) grasped the basic MI spirit but failed to understand specific MI techniques due to insufficient training practice; (b) perceived ProLife as having benefitted the patients (as well as themselves); (c) viewed the SMSs favorably; but (d) considered limited space and privacy at the clinics as key challenges. The ProLife program targeting multiple risk behaviors in TB patients is acceptable but LHW training protocol, and changes in wording and delivery of SMS are necessary to improve the intervention. Trial registration: ISRCTN14213432
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In adult patients with TB in South Africa, patients reported the intervention was helpful, enjoyable, and helped them reduce smoking and drinking; most reported better adherence to TB treatment; all reported liking their interaction with counselor; several did not like the session being recorded, and some struggled to understand messages or had technical issues.
“Patients reported the intervention was helpful, enjoyable, and helped them reduce smoking and drinking. Most patients reported better adherence to TB treatment. All patients reported liking their interaction with counselor. Several patients did not like the session being recorded, some struggled to understand messages or had technical issues.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [99]
Goedele et al reported that providers felt unprepared for the diversity of problems, attitudes, and beliefs that patients presented with.
“Goedele et al. [99] reported that the providers felt unprepared for the diversity of problems, attitudes, and beliefs that the patients presented with.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [99]
In adult patients with TB in South Africa, nearly all patients (93.3%) received their first MI counseling session, but close to 30% failed to receive their second or third MI session; two patients died due to causes unrelated to the study.
“Nearly all patients (93.3%) received their first MI counseling session, but close to 30% failed to receive their second or third MI session due to various reasons. Two patients died due to causes that were unrelated to the study.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [99]
In adult patients with TB in South Africa, lay providers felt positive about the training received but felt unprepared for the diversity of problems, attitudes, and beliefs that patients presented with.
“Overall, lay providers felt positive about the training received; They however felt unprepared for the diversity of problems, attitudes, and beliefs that patients presented with.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [99]
In adult patients with TB in South Africa, nearly one third were eligible because of exclusively drinking (28.9%), 31.1% because of exclusively smoking, and 40.0% for concurrently drinking and smoking.
“Nearly one third of the patients were eligible because of exclusively drinking (28.9%), 31.1% because of exclusively smoking and 40.0% for concurrently drinking and smoking.”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [99]
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- Authors
- Louwagie, G. M., Morojele, N., Siddiqi, K., Mdege, N. D., Tumbo, J., Omole, O., Pitso, L., Bachmann, M. O., & Ayo-Yusuf, O. A.
- Affiliations
- Sefako Makgatho Health Sciences University (ZA)
- Alcohol, Tobacco and Other Drug Research Unit, Medical Research Council, Pretoria, South Africa
- University of York (GB)
- Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa
- University of Pretoria (ZA)
- University of East Anglia (GB)
- Corresponding author
- Louwagie, Goedele M
- ORCID
- Venue
- Translational Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2019-06-24
- Volume
- 10
- Issue
- 6
- Pages
- 1491-1503
- ISSN
- 1613-9860 (ISSN-L)
- 1869-6716
- OpenAlex
- W2953931369
- Cited by
- 17
- References
- 46
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 1 · 2022: 5 · 2021: 2 · 2020: 1
- FWCI
- 1.53
- Type
- journal article
- Language
- en
- Open access
- green
- orcid.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- Translational Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- UpSpace Institutional Repository (University of Pretoria) (submittedVersion)
- Funders
- South Africa Medical Research/Newton Foundation (MRC-RFA-02: TB-05-2015)
- National Research Foundation of South Africa (109318)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- tuberculosis, smoking, alcohol consumption, lay health workers, motivational interviewing, short message service, medication adherence, HIV, behavioral interventions, treatment outcomes, intervention fidelity, South Africa
- MeSH terms
- Tobacco Smoking, Adult, Feasibility Studies, Humans, Male, South Africa, Tuberculosis, Treatment Outcome
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