Readiness of tuberculosis treatment centres in Masaka district to provide tobacco cessation services.
MUTEBI, RONALD REAGAN
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Background: In Uganda, tobacco use is still significant and has been associated with non-communicable (NCDs) and communicable diseases including tuberculosis. The World Health Organisation (WHO) and Frame Work Convention on Tobacco Control (FCTC) recommend integration of tobacco cessation services (TCS) into clinical services especially in tuberculosis (TB) infected individuals. Implementation of TCS alongside TB management in Masaka district was not documented. This study set out to document levels of preparedness for the TB treatment centres in Masaka district to implement TSC. Methods: This was a cross section sequential explanatory mixed methods study, done in the 14 TB Treatment Centers of Masaka district in the month of July, 2018. We developed and applied a structured tool to assess the presence of key health systems’ tracer elements as recommended by the WHO and CDC in delivering implementable tobacco control strategies in health facility settings. Levels of preparedness were determined and presented as proportions (index scores) for availability of key tracer elements. In addition, perceptions towards implementation of TCS using key informant (KI) interviews for health workers and focus group discussions (FGD) for Community Based Directly Observed Therapy (CBDOTs) supervisors were done through direct and summative content analysis. Results: Overall, TB treatment centres were not prepared to implement TCS with readiness index of 23.4%. Readiness to implement; Monitoring tobacco use interventions was 28.57%, Protecting people from exposure to second hand smoke (SHS) was at 14.3%, Offering to quit tobacco use was 28.9% and Warning about dangers of tobacco use was at 21.4%. There was a positive trend in readiness levels through the ascending levels of health care at 20.0% and 32.0% readiness for the secondary and tertiary institutions respectively. Health care workers revealed perceived lack of effectiveness for counseling services rendered to smokers and negative attitudes towards nicotine replacement therapy (NRT). Lack of formal training in TCS, high work load for health workers, lack of funding and absence of bi-laws at community were the most significant challenges mentioned by respondents. Improved staffing norms to include counselors at health facilities, appointment of focal persons, provision of tools for data collection, more involvement of community structures like schools and leaders were advanced as possible solutions to the challenges. Conclusion: Readiness to provide TCS as per the recommendations of the WHO- FCTC policies was low in Masaka district. These services were not adequately integrated into TB services’ provision. Improving financing to facilitate activity implementation, appointment of focal persons and prioritization of reporting on tobacco use indicators by the MoH, Development Partners and DHTs would significantly accelerate implementation of the WHO-FCTC strategies in health facility settings especially TB clinic.