Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
Centre for Tobacco Control in Africa, Kampala, Uganda.
BMC Public Health. 2021 Jul 28;21(1):1464. doi: 10.1186/s12889-021-11502-4.
Tobacco use is associated with exacerbation of tuberculosis (TB) and poor TB treatment outcomes. Integrating tobacco use cessation within TB treatment could improve healing among TB patients. The aim was to explore perceptions of health workers on where and how to integrate tobacco use cessation services into TB treatment programs in Uganda.
Between March and April 2019, nine focus group discussions (FGDs) and eight key informant interviews were conducted among health workers attending to patients with tuberculosis on a routine basis in nine facilities from the central, eastern, northern and western parts of Uganda. These facilities were high volume health centres, general hospitals and referral hospitals. The FGD sessions and interviews were tape recorded, transcribed verbatim and analysed using content analysis and the Chronic Care Model as a framework.
Respondents highlighted that just like TB prevention starts in the community and TB treatment goes beyond health facility stay, integration of tobacco cessation should be started when people are still healthy and extended to those who have been healed as they go back to communities. There was need to coordinate with different organizations like peers, the media and TB treatment supporters. TB patients needed regular follow up and self-management support for both TB and tobacco cessation. Patients needed to be empowered to know their condition and their caretakers needed to be involved. Effective referral between primary health facilities and specialist facilities was needed. Clinical information systems should identify relevant people for proactive care and follow up. In order to achieve effective integration, the health system needed to be strengthened especially health worker training and provision of more space in some of the facilities.
Tobacco cessation activities should be provided in a continuum starting in the community before the TB patients get to hospital, during the patients' interface with hospital treatment and be given in the community after TB patients have been discharged. This requires collaboration between those who carry out health education in communities, the TB treatment supporters and the health workers who treat patients in health facilities.
吸烟与结核病（TB）恶化和结核病治疗效果不佳有关。将戒烟纳入结核病治疗中可能会改善结核病患者的康复情况。本研究旨在探讨乌干达卫生工作者对在何处以及如何将戒烟服务纳入结核病治疗方案的看法。
2019 年 3 月至 4 月，在乌干达中部、东部、北部和西部的 9 个设施中，对常规照顾结核病患者的卫生工作者进行了 9 次焦点小组讨论（FGD）和 8 次关键知情人访谈。这些设施是高容量保健中心、综合医院和转诊医院。FGD 会议和访谈进行了录音，逐字记录下来，并使用内容分析和慢性病护理模型作为框架进行了分析。
受访者强调，就像结核病预防始于社区，结核病治疗不仅仅局限于医疗机构一样，戒烟的整合应该在人们还健康的时候开始，并扩展到那些已经康复的人，因为他们回到社区。需要与不同的组织（如同行、媒体和结核病治疗支持者）协调。结核病患者需要定期随访和自我管理支持，包括结核病和戒烟。需要赋予患者权力，让他们了解自己的病情，同时让他们的照顾者参与进来。需要在初级保健机构和专科机构之间进行有效的转诊。临床信息系统应识别出需要主动护理和随访的相关人员。为了实现有效的整合，需要加强卫生系统，特别是对卫生工作者进行培训，并在一些设施中提供更多的空间。
应该在一个连续的过程中提供戒烟活动，从社区开始，在结核病患者到达医院之前，在患者与医院治疗接触期间，并在结核病患者出院后在社区提供。这需要在社区开展健康教育的人员、结核病治疗支持者以及在医疗机构治疗患者的卫生工作者之间进行合作。
