Behavioural support programme to make TB patients quit smoking receives BUPA Foundation prize

The BUPA Foundation has awarded a high commendation prize for research led by the University of York into effective ways of helping tuberculosis patients in Pakistan to give up smoking.

The prize worth £5,000 was presented at the annual BUPA Foundation Healthy Lives Prize Awards, which recognise work that helps people to make sustained behaviour changes towards a healthy lifestyle.

Under the smoking cessation project led by Dr Kamran Siddiqi of the University's Department of Health Sciences and the Hull York Medical School (HYMS), researchers spent three years carrying out a randomised controlled trial in primary health care in Pakistan.

The aim was to design and then evaluate the effectiveness of a behavioural support programme, with and without the use of the drug bupropion, to encourage patients suffering from tuberculosis (TB) to give up smoking permanently.

The behavioural support programme included two brief counselling sessions by health care staff responsible for delivering TB care in Pakistan.

The results showed that both treatment options - behavioural support with or without bupropion - led to significantly improved abstinence rates compared to usual care alone. They conclude that behavioural support intervention is effective and cost-effective in achieving smoking cessation among smokers in Pakistan with suspected TB.

The research was carried out in collaboration with the Association of Social Development, Pakistan. It is the first smoking cessation trial carried out in TB patients globally and one of the very few carried out in low- and middle-income countries.

Dr Siddiqi, a Clinical Senior Lecturer in Epidemiology and Public Health, said: "There is a strong causal link between tobacco use and TB incidence with almost 20 per cent of global TB deaths attributable to smoking. Pakistan is one of the top ten countries in terms of both tuberculosis and tobacco use.

"It is therefore important to integrate smoking cessation interventions into TB care. In light of the evidence generated from the trial, we are recommending that behaviour support intervention is integrated into the existing national TB programme."

The first phase of the project, which was funded by the International Development Research Centre, Canada, involved identifying behavioural support likely to be effective in encouraging TB patients to give up smoking. This was followed by a pilot trial, then a randomised controlled trial which assessed the effectiveness of a behavioural support programme alone, a behavioural support programme in combination with bupropion, and usual care with a self-help leaflet, in achieving six months abstinence from smoking.

The trial, which involved 1,957 people, showed that 42.1 per cent of those offered behavioural support and bupropion achieved six months abstinence, compared with 39.8 per cent offered behavioural support alone and 7.9 per cent offered usual care and a self-help leaflet.

Behavioural support intervention alone proved most cost-effective. It has been adopted by the national TB control programme and is now being introduced nationwide in Pakistan in a phased manner.