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Impact of connecting tuberculosis directly observed therapy short-course with smoking cessation on health-related quality of life

Ahmed Awaisu1*, Mohamad Haniki Nik Mohamed2, Noorliza Mohamad Noordin3, Abdul Razak Muttalif4, Noorizan Abd Aziz5, Syed Azhar Syed Sulaiman6 and Aziah Ahmad Mahayiddin4

Author Affiliations

1 College of Pharmacy, Qatar University, P.O. Box 2713, Doha, Qatar

2 Faculty of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Malaysia

3 Institute for Health Management, Ministry of Health, 59000 Kuala Lumpur, Malaysia

4 Institute for Respiratory Medicine, 53000 Wilayah Persekutuan, Kuala Lumpur, Malaysia

5 Faculty of Pharmacy, Universiti Technology Mara, 5600 Puncak Alam, Malaysia

6 School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 Penang, Malaysia

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Tobacco Induced Diseases 2012, 10:2  doi:10.1186/1617-9625-10-2

Published: 28 February 2012



With evolving evidence of association between tuberculosis (TB) and tobacco smoking, recommendations for the inclusion of tobacco cessation interventions in TB care are becoming increasingly important and more widely disseminated. Connecting TB and tobacco cessation interventions has been strongly advocated as this may yield better outcomes. However, no study has documented the impact of such connection on health-related quality of life (HRQoL). The objective of this study was to document the impact of an integrated TB directly observed therapy short-course (DOTS) plus smoking cessation intervention (SCI) on HRQoL.


This was a multi-centered non-randomized controlled study involving 120 TB patients who were current smokers at the time of TB diagnosis in Malaysia. Patients were assigned to either of two groups: the usual TB-DOTS plus SCI (SCIDOTS group) or the usual TB-DOTS only (DOTS group). The effect of the novel strategy on HRQoL was measured using EQ-5D questionnaire. Two-way repeated measure ANOVA was used to examine the effects.


When compared, participants who received the integrated intervention had a better HRQoL than those who received the usual TB care. The SCIDOTS group had a significantly greater increase in EQ-5D utility score than the DOTS group during 6 months follow-up (mean ± SD = 0.98 ± 0.08 vs. 0.91 ± 0.14, p = 0.006). Similarly, the mean scores for EQ-VAS showed a consistently similar trend as the EQ-5D indices, with the scores increasing over the course of TB treatment. Furthermore, for the EQ-VAS, there were significant main effects for group [F (1, 84) = 4.91, p = 0.029, η2 = 0.06], time [F (2, 168) = 139.50, p = < 0.001, η2 = 0.62] and group x time interaction [F (2, 168) = 13.89, p = < 0.001, η2 = 0.14].


This study supports the evidence that an integrated TB-tobacco treatment strategy could potentially improve overall quality of life outcomes among TB patients who are smokers.

DOTS; Outcomes; Quality of life; Smoking cessation intervention; Tuberculosis