# Factors affecting the integration of tobacco cessation services for TB patients

## TL;DR

This study explores the challenges and opportunities for integrating smoking cessation services into TB and HIV care in Botswana to improve patient outcomes.

## Contribution

The study identifies specific barriers and facilitators to integrating tobacco cessation services for TB and HIV patients using a mixed-methods approach.

## Key findings

- Tobacco knowledge alone is not enough to support smoking cessation.
- Healthcare providers lack the skills and confidence to deliver cessation services.
- Partnerships with NGOs can help but may affect long-term program sustainability.

## Abstract

Tobacco smoking remains a serious health threat, especially for patients with TB and HIV. Cessation services may be apt for integration into TB and HIV clinics, particularly in lower- and middle-income countries, where these services often have robust structures. We aimed to identify barriers and facilitators to the integration of smoking cessation within health care services for people with HIV on TB treatment in Botswana.

Using the Consolidated Framework for Implementation Research 2.0, we conducted a convergent parallel mixed-methods study collecting demographic data on current TB patients and semi-structured interviews with patients and providers.

We identified four key themes on programme implementation: 1) Tobacco knowledge is necessary but insufficient to facilitate smoking cessation; 2) Providers lack skill to provide cessation services and are apprehensive about interactions with TB patients; 3) An intervention would be desirable but will require additional infrastructure and cannot exclude other non-TB populations; and 4) Leveraging non-governmental implementation partners would be an asset but may also impede programme longevity.

Novel approaches are needed to overcome key barriers to the integration of smoking cessation treatments for this important subgroup of smokers, including developing a comprehensive tobacco treatment programme that can extend beyond education and provide critical skills for providers.