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

• Published in: BMJ open 2022-02, Vol.12 (2), p.e056496
• Main Authors: Louwagie, Goedele, Kanaan, Mona, Morojele, Neo Keitumetse, Van Zyl, Andre, Moriarty, Andrew Stephen, Li, Jinshuo, Siddiqi, Kamran, Turner, Astrid, Mdege, Noreen Dadirai, Omole, Olufemi Babatunde, Tumbo, John, Bachmann, Max, Parrott, Steve, Ayo-Yusuf, Olalekan A
• Format: Article
• Language: English
• Subjects: Adult; Alcohol use; Antiretroviral drugs; Cellular telephones; Clinical outcomes; Clinics; Counseling; Data collection; health economics; Health education; Health risk assessment; Health risks; HIV; HIV & AIDS; HIV Infections; Human immunodeficiency virus; Humans; Intervention; Lifestyles; Low income groups; Medication Adherence; Mortality; Motivational Interviewing; organisation of health services; Patient compliance; Public Health; Smoking cessation; South Africa; substance misuse; Telemedicine; Text Messaging; Tobacco; Tobacco Smoking; Treatment Outcome; Tuberculosis; Tuberculosis - drug therapy
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2021-056496

ObjectiveTo investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking.DesignMulticentre, individual, randomised controlled trial where participants were assigned (1:1) to the ProLife intervention or usual care.Setting27 primary care clinics in South Africa.Participants574 adults starting treatment for drug-sensitive pulmonary TB who smoked tobacco or reported harmful/hazardous alcohol use.InterventionsThe 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 measuresThe 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.ResultsBetween 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).ConclusionsSimultaneous targeting of multiple health risk behaviours with MI and SMS using LHWs may not be an effective approach to improve TB outcomes.Trial registration numberISRCTN62728852.