Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised controlled trial of the ProLife programme in South Africa
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Objective: To investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking. Design: Multicentre, individual, randomised controlled trial where participants were assigned (1:1) to the ProLife intervention or usual care. Setting: 27 primary care clinics in South Africa. Participants: 574 adults starting treatment for drug-sensitive pulmonary TB who smoked tobacco or reported harmful/hazardous alcohol use. Interventions: The intervention, delivered by lay health workers (LHWs), consisted of three brief motivational interviewing (MI) sessions, augmented with short message service (SMS) messages, targeting medication adherence, alcohol use and tobacco smoking. Outcome measures: The primary outcome was successful versus unsuccessful TB treatment at 6–9 months, from TB records. Secondary outcomes were biochemically confirmed sustained smoking cessation, reduction in the Alcohol Use Disorder Identification Test (AUDIT) score, improved TB and antiretroviral therapy (ART) adherence and ART initiation, each measured at 3 and 6 months by questionnaires; and cure rates in patients who had bacteriology-confirmed TB at baseline, from TB records. Results: Between 15 November 2018 and 31 August 2019, 574 participants were randomised to receive either the intervention (n=283) or usual care (n=291). TB treatment success rates did not differ significantly between intervention (67.8%) and control (70.1%; OR 0.9, 95% CI 0.64% to 1.27%). There was no evidence of an effect at 3 and 6 months, respectively, on continuous smoking abstinence (OR 0.65, 95% CI 0.37 to 1.14; OR 0.76, 95% CI 0.35 to 1.63), TB medication adherence (OR 1.22, 95% CI 0.52 to 2.87; OR 0.89, 95% CI 0.26 to 3.07), taking ART (OR 0.79, 95% CI 0.38 to 1.65; OR 2.05, 95% CI 0.80 to 5.27) or AUDIT scores (mean score difference 0.55, 95% CI −1.01 to 2.11; −0.04, 95% CI −2.0 to 1.91) and adjusting for baseline values. Cure rates were not significantly higher (OR 1.16, 95% CI 0.83 to 1.63). Conclusions: Simultaneous targeting of multiple health risk behaviours with MI and SMS using LHWs may not be an effective approach to improve TB outcomes. Trial registration number: ISRCTN62728852.
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Goedele et al found no BI effect for tobacco use at 3 and 6 months.
“Goedele et al [84] found no BI effect for tobacco use at 3 and 6 months (Table 2).”
From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [84]
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Efficacy and Best Practices of Health-care worker Smoking Cessation Treatment in Sub-Saharan AfricaPreprint
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Nudging für Präventionsmaßnahmen in der Neurologie?
Tollens, N., & Schäffer, E. (2025) · DGNeurologie · doi:10.1007/s42451-025-00820-1
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- Authors
- Louwagie, G., Kanaan, M., Morojele, N. K., Van Zyl, A., Moriarty, A. S., Li, J., Siddiqi, K., Turner, A., Mdege, N. D., Omole, O. B., Tumbo, J., Bachmann, M., Parrott, S., & Ayo-Yusuf, O. A.
- Affiliations
- Sefako Makgatho Health Sciences University (ZA)
- University of York (GB)
- South African Medical Research Council (ZA)
- Research, Postgraduate Studies and Innovation, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- University of Pretoria (ZA)
- University of the Witwatersrand (ZA)
- University of East Anglia (GB)
- Corresponding author
- Louwagie, Goedele
- ORCID
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2022-02
- Volume
- 12
- Issue
- 2
- Pages
- e056496
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC8845202
- OpenAlex
- W4212808479
- Cited by
- 44
- References
- 58
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 16 · 2023: 6 · 2022: 4
- FWCI
- 4.39
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMJ Open (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion, cc-by)
- UEA Digital Repository (University of East Anglia) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UpSpace Institutional Repository (University of Pretoria) (submittedVersion, cc-by)
- Funders
- Medical Research Council South Africa (MRC-RFA-02: TB -05-2015)
- Medical Research Council United Kingdom (MRC-RFA-02: TB -05-2015)
- Newton Fund (MRC-RFA-02: TB -05-2015)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- tuberculosis, motivational interviewing, text messaging intervention, smoking cessation, alcohol consumption, medication adherence, antiretroviral therapy adherence, lay health workers, tuberculosis treatment outcomes, primary care, South Africa, HIV/TB coinfection, health behavior change, antiretroviral therapy initiation, TB cure rate, AUDIT score, Xhosa, isiZulu
- MeSH terms
- Tobacco Smoking, Adult, Humans, South Africa, Tuberculosis, HIV Infections, Treatment Outcome, Medication Adherence, Text Messaging, Motivational Interviewing
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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