Strengthening integration of TB and tobacco control in primary care through ICT tools

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1 Strengthening integration of TB and tobacco control in primary care through ICT tools Dongbo Fu WHO/PND/TFI 1

2 Outline Background Scientific foundations Potential impact PND-GTP earlier collaboration and past success Policy recommendations on joint TB and tobacco control Case examples Existing technical resources/tools How ICT tools could support nationwide integration of TB and tobacco control in primary care? 2

3 The confirmed associations between tobacco and TB lay the scientific foundations for joint action A Qualitative Systematic Review Jointly Conducted by WHO GTB, TFI and The Union in 2007 concluded that: Active or passive tobacco smoking is significantly associated with TB infection and TB disease. Active smoking is significantly associated with recurrent TB and TB mortality. 3

4 Tobacco cessation intervention positively impact TB treatment outcomes At the end of TB treatment (6 months or later): Treatment outcomes Intervention group (conventional TB DOTS + smoking cessation intervention ) Control group (conventional TB DOTS alone) p-value Treatment default 2.5% 15.2% < 0.05 Treatment failure 0% 6.5% < 0.05 Source: Awaisu A, et al. The SCIDOTS Project: Evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes. Substance Abuse Treatment, Prevention and Policy 6: e-article 26,

5 The NTP could help significantly improve access to tobacco cessation interventions 5 Source: WHO report o n the global tobacco epidemic, 2013

6 The NTP could help significantly improve access to tobacco cessation interventions DOTS programmes have the potential to reach more than 1 million tobacco users a year About 6.1 million new and relapse TB cases notified by NTPs in Even if only 20% of them use tobacco, the NTPs could reach >1 million tobacco users a year The Practical Approach to Lung Health (PAL) has the potential to reach 20-35% patients in PHC setting Source: Global Tuberculosis Report

7 WHO & The Union recommendations on TB and tobacco control Providing treatment of tobacco dependence for TB patients in primary care Brief advice (Five As, Five Rs) Intensive support Pharmacological interventions Making the clinic where TB patients are treated for tobacco dependence smoke-free Taking managerial decisions to overcome barriers in the health system to institute treatment for tobacco dependence 7

8 Case examples-nepal Integrating brief advice into PAL Practical Approach to Lung Health (PAL) is a patient-centred approach aims to improve TB diagnosis and care by improving the quality of care for every respiratory patient in PHC settings PAL is an existing PHC program, initiated in 2001 in Nepal Approximately 2 million respiratory patients seek care in PHC Integrating brief advice into PAL initiative in two pilot districts as a WHO pilot project ( ): Secured support from policy makers PAL guideline includes tobacco control component Training ( trained 17 future trainers, 146 health workers) Integrated smoking status into PAL register 8

9 Case examples-nepal Integrating brief advice into PAL Impact/outcome (data from one PHC facility) Number and percentage of smokers identified among respiratory disease patients Number and percent of patients with respiratory diseases who are current smokers who have been given brief routine counseling to quit smoking Number and percentage of patients receiving smoking cessation counseling who quit smoking for 6 months 59.1% (n=88) 22.2% 23% Integration of brief advice with PAL planned to expand to 25 districts during through the Global Fund NSA funding Source: PPT slides from Dr Pushpa Malla, Nepal,

10 Case examples-india Integrating brief advice into DOTS Brief advice for tobacco cessation based on five A s, advocated by the WHO and The Union was incorporated into the on-going TB Control programme in India in the year registered TB patients receiving directly observed treatment short-course (DOTS) who used tobacco in any form were offered brief advice At the end of treatment, 67.3% of the patients who were offered brief advice, quit tobacco use. Source: Jagdish Kaur, et al. Promoting tobacco cessation by integrating brief advice in tuberculosis control programme. WHO South-East Asia Journal of Public Health,

11 Case examples-cambodia, Philippines and Nepal Integrating brief advice into DOTS Cambodia-- Integrating brief advice into DOTS in primary care in one province Brief advice for tobacco cessation based on 5A s and 5R's, was integrated into DOTS, during Philippines-- Integrating brief advice into DOTS in primary care in three regions Brief advice for tobacco cessation based on 5A s and 5R's, was integrated into DOTS, during Nepal -- Integrating brief advice into DOTS in primary care in two districts Brief advice for tobacco cessation based on 5A s and 5R's, was integrated into DOTS, during

12 Case examples-cambodia, Philippines and Nepal Integrating brief advice into DOTS Country No. of TB patients treated No. and % of smokers identified No. and % of smokers received advice to quit No. and % of smokers quit successfully in 3 to 4 months Cambodia 73 41(56.2%) 41(100%) 18 (43.9%) Nepal (37.2%) 19(100%) 4(21.0%) The Philippines (44.5%) 435(100%) 98(22.5%) 12

13 Technical resources/tools available for countries to implement the WHO/The Union policy recommendations A WHO/The Union monograph on TB and tobacco control A WHO capacity building training package entitled "Strengthening health system for treating tobacco dependence in primary care" TB & Tobacco policy fact sheet developed by GTB and TFI Self-help tobacco cessation materials for TB patients A brief tobacco intervention toolkit for TB care providers 13

14 Next stage: A nationwide integration The whole health system needs to function well to support the integration in primary care Intervention activities Leadership and governance Service delivery Develop and implement national policies on joint TB and tobacco control in primary care Setting specific objectives Develop integrated service delivery model and referral system Make TB care facilities smoke-free Health workforce Training on brief tobacco interventions for smokers and non-smokers Information Medical products and technologies Financing Include smoking status and smoking cessation outcome into TB Treatment Register Develop and distribute smoking cessation self-help materials and technical guide If appropriate, make cessation medications available If appropriate, develop and implement effective mechanisms, including financial incentives to sustain the integrated service delivery 14

15 e/mhealth: an effective way to strengthen health systems e/mhealth tools can be used to bring about system-level changes in multiple ways e/mhealth tools Leadership and governance Service delivery Health workforce Information Medical products and technologies Financing Electronic medical records(emr) can serve as a tool for monitoring and performance feedback, and gather high quality data for decisions. EMR to improve the delivery of brief tobacco interventions by PHC providers. Telephone quit line and mcessation can increase PHC provider's willingness to conduct routine brief tobacco interventions. E-learning/online courses to train health care providers on brief tobacco interventions. EMR to record tobacco use and to serve as a clinician reminder to provide brief advice to quit and to facilitate referrals. Internet, , telephone, text message can be used to improve referrals and follow-up with tobacco users on their quit attempts. Electronic medical records can improve healthcare quality and costs. 15

16 Thank you for your attention

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