Smoking Cessation in DOTS Clinics in Rio de Janeiro

Introduction: Tuberculosis (TB) causes an estimated two million deaths per year worldwide, and Brazil currently ranks 15th worldwide in numbers of TB cases among the 22 highest disease burden countries. TB is a serious public health problem in the many low- and middle-income countries, particularly in densely populated areas such as Rio de Janeiro. Smoking and second-hand smoking increase risk for TB infection and mortality. Despite the fact that a very high percentage of tuberculosis patients smoke (estimated at 40% in Brazil), smoking cessation interventions in such patients have not been reported. Methods: We propose a pilot study of the efficacy of smoking cessation for patients attending Directly Observed Therapy Short Course (DOTS) treatment facilities (n=18) for TB in Rio de Janeiro (n=300). The intervention includes intensive training of DOTS providers (n=27) followed by smoking cessation counseling and NRT. The intervention outcome is confirmed by biochemical urine cotinine testing after 3 and 6 months. Results: We expect quit rates of 15-20% among TB patients in the intervention group, against 5% in the control group. We are also evaluating the impact on TB treatment outcomes, through sputum conversion time and completion of DOTS therapy. Discussion and conclusions: The implications of the research may be very significant in that the addition of smoking cessation treatment to DOTS programs will likely improve the health of TB patients in general, reduce treatment failures, and reduce overall mortality and morbidity due to TB among smokers