Louwagie, Goedele M.C.Kanaan, MonaMorojele, Neo KeitumetseVan Zyl, AndreMoriarty, Andrew StephenLi, JinshuoSiddiqi, KamranTurner, Astrid ChrisildaMdege, Noreen DadiraiOmole, Olufemi BabatundeTumbo, JohnBachmann, MaxParrott, SteveAyo-Yusuf, Olalekan Abdulwahab2022-07-212022-07-212022-02Louwagie, G., Kanaan, M., Morojele , N.K., Van Zyl, A., Moriarty , A.S., Li, J., Siddiqi, K., Turner, A., Mdege, N.D., Omole, O.B.,, John Tumbo, J., Bachmann, M., Parrott, S. & Ayo-Yusuf, O.A. Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised controlled trial of the ProLife programme in South Africa. BMJ Open. 2022 Feb 14;12(2):e056496. doi: 10.1136/bmjopen-2021-056496.2044-6055 (online)10.1136/bmjopen-2021-056496https://repository.up.ac.za/handle/2263/86348OBJECTIVE: To investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking. DESIGN: Multicentre, individual, randomised controlled trial where participants were assigned (1:1) to the ProLife intervention or usual care. Setting: 27 primary care clinics in South Africa. Participants: 574 adults starting treatment for drug-sensitive pulmonary TB who smoked tobacco or reported harmful/hazardous alcohol use. INTERVENTIONS: The intervention, delivered by lay health workers (LHWs), consisted of three brief motivational interviewing (MI) sessions, augmented with short message service (SMS) messages, targeting medication adherence, alcohol use and tobacco smoking. OUTCOME MEASURES: The primary outcome was successful versus unsuccessful TB treatment at 6-9 months, from TB records. Secondary outcomes were biochemically confirmed sustained smoking cessation, reduction in the Alcohol Use Disorder Identification Test (AUDIT) score, improved TB and antiretroviral therapy (ART) adherence and ART initiation, each measured at 3 and 6 months by questionnaires; and cure rates in patients who had bacteriology-confirmed TB at baseline, from TB records. RESULTS: Between 15 November 2018 and 31 August 2019, 574 participants were randomised to receive either the intervention (n=283) or usual care (n=291). TB treatment success rates did not differ significantly between intervention (67.8%) and control (70.1%; OR 0.9, 95% CI 0.64% to 1.27%). There was no evidence of an effect at 3 and 6 months, respectively, on continuous smoking abstinence (OR 0.65, 95% CI 0.37 to 1.14; OR 0.76, 95% CI 0.35 to 1.63), TB medication adherence (OR 1.22, 95% CI 0.52 to 2.87; OR 0.89, 95% CI 0.26 to 3.07), taking ART (OR 0.79, 95% CI 0.38 to 1.65; OR 2.05, 95% CI 0.80 to 5.27) or AUDIT scores (mean score difference 0.55, 95% CI -1.01 to 2.11; -0.04, 95% CI -2.0 to 1.91) and adjusting for baseline values. Cure rates were not significantly higher (OR 1.16, 95% CI 0.83 to 1.63). CONCLUSION: Simultaneous targeting of multiple health risk behaviours with MI and SMS using LHWs may not be an effective approach to improve TB outcomes.en© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY.Health economicsOrganisation of health servicesPublic healthSubstance misuseTuberculosis (TB)Treatment successMedication adherenceAlcohol useTobacco smokingBehavioural interventionProLifeArticle