Efficacy of brief motivational interviewing on smoking cessation at tuberculosis clinics in Tshwane, South Africa: a randomized controlled trial

• Published in: Addiction (Abingdon, England) England), 2014-11, Vol.109 (11), p.1942-1952
• Main Authors: Louwagie, Goedele M. C., Okuyemi, Kolawole S., Ayo-Yusuf, Olalekan A.
• Format: Article
• Language: English
• Subjects: Addiction; Addictive behaviors; Adult; Adult and adolescent clinical studies; Biological and medical sciences; Carbon monoxide; Clinical trials; Confidence intervals; Desintoxication. Drug withdrawal; Female; Follow-Up Studies; Health Facilities; HIV; Humans; Interviews; lay health-care worker; Male; Medical sciences; Middle Aged; Motivation; Motivational Interviewing; Multilevel Analysis; Mycobacterium; Older people; Patients; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health; randomized controlled trial; Smoking; Smoking - psychology; Smoking cessation; Smoking Cessation - methods; Smoking Prevention; South Africa; Tobacco; tobacco cessation; Tobacco smoking; Tobacco, tobacco smoking; Toxicology; Treatment Outcome; Treatments; Tuberculosis; Tuberculosis - therapy
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/add.12671

Background and Aims Tuberculosis (TB) patients who smoke risk adverse TB outcomes and other long‐term health effects of smoking. This study aimed to determine the efficacy of brief motivational interviewing by lay health‐care workers (LHCWs) in assisting TB patients to quit smoking. Design Multi‐centre two‐group parallel individual randomized controlled trial. Setting Six primary care tuberculosis clinics in a South African township. Participants Newly diagnosed adult TB patients identified as current smokers were randomized to brief motivational interviewing by a LHCW (intervention group, n = 205) or brief smoking cessation advice from a TB nurse (control group, n = 204). Measurements The primary outcome was self‐reported sustained 6‐month smoking abstinence. Exhaled carbon monoxide (CO) testing was offered to about half the participants. Secondary outcomes were sustained abstinence at 3 months; 7‐day point prevalence abstinence at 1, 3 and 6 months; and quit attempts. Allocation was concealed. Primary analysis relied on intention to treat. Multi‐level analysis accounted for site heterogeneity of effect. Findings Self‐reported 6‐month sustained abstinence was 21.5% for the intervention group versus 9.3% for the control group [relative risk (RR) = 2.29, 95% confidence interval (CI) = 1.34, 3.92]. Biochemically verified 6‐month sustained abstinence was also higher in the intervention group (RR 2.21, 95% CI = 1.08, 4.51) for the 166 participants who were offered carbon monoxide testing. Self‐reported 3‐month sustained abstinence was 25.4% for the intervention group and 12.8% for the control group (RR = 1.98, 95% CI = 1.24, 3.18). Conclusions Motivational interviewing by lay counsellors to promote smoking cessation in tuberculosis patients in South Africa approximately doubled sustained smoking abstinence for at least 6 months compared with brief advice alone.