BACKGROUND: Half of the 267 million tobacco users in India are willing to quit tobacco and 35% have made a quit attempt, 70% of whom tried to quit on their own. Only 49% smokers and 30% smokeless tobacco users were advised by their healthcare providers to quit tobacco. This demonstrates a gap in the demand and supply of cessation services in India. Brief advice interventions delivered by diverse healthcare providers with minimal training have shown promise and can be considered a low-cost scalable solution.
METHODS: Task shifting, which involves transferring responsibilities of highly skilled individuals to less specialized workers after due training, can be applied to tobacco cessation. The responsibility of providing cessation advice can be allocated to frontline health workers. LifeFirst, an evidence-based tobacco cessation programme, identified healthcare workers from three high reach, low resource settings – TB NGOs, Health NGOs and Dentists and provided trainings to deliver brief advice interventions and refer for counselling, during routine activities.
RESULTS: LifeFirst trained 15 dentists, 11 TB NGO workers and 40 Health NGO workers. All health workers from the TB and Health NGO setting and 9 (60%) dentists referred at least one tobacco user. In a period of one year, 2866 tobacco users (23% from TB NGOs, 68% from health NGOs and 9% from dentists). Of these, 2346 (82%) registered for counselling. Registration rate was highest among TB NGO health workers (86%) followed by Health NGO (81%) and dentists (79%). The average number of patients who registered for counselling per health worker was 21, 39 and 52 for dentists, Health NGOs and TB NGOs respectively.
CONCLUSIONS: Task shifting approach to deliver brief advice intervention in low resource settings is feasible. Tobacco cessation can be integrated in the TB Program and health initiatives implemented by NGOs through their health workers.