"Leadership in addressing TB and tobacco co-epidemics" | Dr Tara Singh Bam

Dr Tara Singh Bam, Asia Pacific Director for Tobacco Control, Vital Strategies, and Board Director of Asia Pacific Cities Alliance for Health and Development (APCAT) is presenting in End TB Dialogues on "Leadership in addressing TB and tobacco co-epidemics"

Till recently, he served as Asia Pacific Director of International Union Against Tuberculosis and Lung Disease (The Union).

The full session is online at:
https://www.youtube.com/watch?v=8LWXYsne8ig

Thanks

CNS team
www.citizen-news.org

1. Leadership in Addressing TB-Tobacco Co-epidemic Smoking cessation in primary health care: Lessons learned from Tobacco-TB high burden countries Dr. Tara Singh Bam Director, Tobacco Control Asia Pacific, Vital Strategies, Singapore [email protected]

2. BREAKING THE CHAIN OF TRANSMISSION TO END TUBERCULOSIS Early screening Early diagnosis Early treatment

3. 10.6 million People fell ill with TB in 2022 1.3 million The total number of deaths caused by TB in 2022 1,133 million Globally, at least 1,133, ages 15 or older were current smokers in 2019. 8 million People die due to tobacco use each year globally Global burden of TB and Tobacco the deadly intersection 0.73 million TB attributable to tobacco smoking 16% Deaths by TB are attributable to tobacco smoking TB Tobacco TB-Tobacco Source: WHO Global TB Report, 2023

4. Estimated number of TB cases attributable to five risk factors, in some high TB burden countries, 2022 Source: WHO Global TB Report, 2023

5. Estimated number of total TB cases and TB cases attributable to smoking, 2022 Source: WHO Global TB Report, 2023 31% 20% 29% 17% 21% 28% 27% 21%

6. Tuberculosis-related deaths due to tobacco Percentage of Tuberculosis-related deaths due to tobacco Smoking increases the risk of developing TB and makes its treatment less effective. About 16 percent of deaths by tuberculosis were attributable to tobacco use in 2019 worldwide

7. The impact of tobacco use on TB outcomes Exposure to tobacco Outcome Risk ratio Strength of evidence Active/passive TB infection 1.03 to 3.2* Limited Active TB disease 1.01 to 6.3* Strong Passive TB disease 1.6 to 9.3* Strong Active Recurrent TB 2.5 to 3.1* Moderate Active Mortality 1.02 to 6.6* Limited Active Delay in diagnosis 1.24 to 7.4** Strong *WHO/The Union (2007) Monograph on TB and Tobacco Control ** Rabin AS, et al. Prescribed and self-medication use increase delays in diagnosis of tuberculosis in the country of Georgia. Int J Tuberc Lung Dis. 2013;17:214–220. Extensive scientific research underscores smoking's substantial role in TB, amplifying the risk of infection, mortality, treatment relapse, heightened clinical severity, and delays in both diagnosis and treatment

8. The impact of tobacco use on delay in TB diagnosis and treatment Bam TS, Enarson DA, Hinderaker SG, Bam DS (2012). Longer delay in accessing treatment among current smokers with new sputum smear-positive tuberculosis in Nepal. Int J Tuberc Lung Dis 16 (6):822-827.

9. Building local L eadership, Accountability and Sustainability for Tobacco Control and addressing TB-Tobacco Co-epidemic Local actions for tobacco control Tobacco control policy and program Public education Smoking cessation Youth engagement STOP tobacco industry interference Local actions to combat TB Awareness campaign Screening and early detection Treatment adherence support Stigma reduction Collaborative efforts

10. Local action to address TB-Tobacco epidemics Smoking cessation through regular TB services in primary health care Local leadership and local action

11. Identification of smokers: DO YOU SMOKE? Higher smoking prevalence among people with TB Source: Bam et al. BMC Public Health (2015) 15: 604; Kaur et al. WHO South East Asia Journal of Public Health (2013) 2:1 ; Jonathan Golub, Johns Hopkins 2018; India GATS 2016-2017; WHO report on the global tobacco epidemic, 2017

12. Brief advise through regular TB services resulted higher quit rates of smoking in people with TB

13. Brief advise through regular TB services resulted in creating smokefree homes in Bogor city, Indonesia Reduction of exposure to Secondhand smoke at home at month 6 compared to baseline at month zero Proportion of the patients Source: Bam TS et al. BMC Public Health. 2015 Month Zero

14. Benefit of tobacco control interventions in TB control program

15. Conclusions: Investment in tobacco control policies to reduce TB burden Implement visually striking graphic health warnings related to TB on tobacco packs Investment in tobacco cessation policies and practices to reduce the global TB and tobacco-related disease burden. TB patients who quit smoking might be more likely to cough less and, thereby, transmit less to their household contacts Brief advise and public education on the effects of tobacco smoking in TB might help early diagnosis and early treatment of TB, thus reduce transmission of TB in communities TB patients who stop tobacco smoking have better treatment success (91% vs 80%) and lower relapse rates (6% vs 14%) Smoking increases risk of TB

16. From control to elimination It is time to change people’s perspective from ‘begging’ to “demanding” governments to act – Building public voices (people with TB and people without TB) No targets – Find ALL and Treat ALL – Community based universal screening Building whole-of-government and whole-of-societal approach for TB elimination – Local leadership, local actions and One H ealth approach Domestic resources – higher taxes on harmful products – tobacco, alcohol, sugary and sweetened beverages TB Law is required