integrated approach to treat tobacco addiction in countries with high tuberculosis incidence

Communicable diseases as well as maternal and child health in low- and middle-income countries continue to be the main focus of global attention. There are also rising trends in the prevalence of non-communicable diseases and further increases are predicted. Several countries are facing this 'dual burden of disease'. There is therefore a need to find ways to integrate the prevention and control of non-communicable diseases into the current health agenda. Tobacco treatment interventions in patients suspected with tuberculosis (TB) offer one such opportunity for a linked healthcare response. Many countries with a high incidence of TB are doubly burdened by an epidemic of tobacco use and tobacco-related diseases. Tobacco use increases the risk of TB infection and is associated with poor treatment compliance, increases in relapse rates and higher secondary mortality. In countries where TB is epidemic, this modest relative risk of infection leads to a significant attributable risk. Regular clinical contact with patients suspected with TB during the diagnosis and treatment phases provides considerable opportunity for health promotion to influence their tobacco-related behaviour. Consequently, treating tobacco addiction in patients suspected with TB is likely to improve the control of TB and prevent tobacco-related diseases. However, despite a high prevalence of tobacco use among TB patients, the treatment of tobacco addiction has not been a priority of TB control programmes. In countries with the dual epidemics of TB and tobacco use, considerable health and economic gains could potentially be made. If effective, such an approach would be highly desirable. We argue that further research assessing the cost-effectiveness and feasibility of linking healthcare interventions such as the treatment of tobacco addiction among TB suspects should receive high priority.