Clearing the smoke around the TB-HIV syndemic: smoking as a critical issue for TB and HIV treatment and care

The collision of the tuberculosis (TB) and human immunodeficiency virus (HIV) epidemics has been described as a 'syndemic' due to the synergistic impact on the burden of both diseases. This paper explains the urgent need for practitioners and policy makers to address a third epidemic that exacerbates TB, HIV and TB-HIV. Tobacco use is the leading cause of preventable death worldwide. Smoking is more prevalent among persons diagnosed with TB or HIV. Smoking is associated with tuberculous infection, TB disease and poorer anti-tuberculosis treatment outcomes. It is also associated with an increased risk of smoking-related diseases among people living with HIV, and smoking may also inhibit the effectiveness of life-saving ART. In this paper, we propose integrating into TB and HIV programmes evidence-based strategies from the 'MPOWER' package recommended by the World Health Organization's Framework Convention on Tobacco Control. Specific actions that can be readily incorporated into current practice are recommended to improve TB and HIV outcomes and care, and reduce the unnecessary burden of death and disease due to smoking.

Strengthening government tobacco control in low- and middle-income countries: a 'must do' for lung health progress

Tobacco control in low- and middle-income countries (LMICs) must gather pace in the coming decade to reverse the increasing prevalence of tobacco use and counter the intensive development of LMIC markets by the tobacco industry. If unchecked, this could undermine wider developments and gains in lung health, for example for people with tuberculosis (TB), TB and human immunodeficiency virus co-infection, asthma and chronic obstructive pulmonary disease. The issue of sustainability for tobacco control in LMICs is also pressing. This perspective article proposes that greater engagement with governments at the national and sub-national levels to strengthen their capacity for effective tobacco control, scale up action and sustain tobacco control is critical. There is also considerable scope to widen effort and impact by building tobacco control into broader initiatives, particularly into those relating to lung health. This paper draws on examples from the tobacco control technical support and capacity building in LMICs of the International Union Against Tuberculosis and Lung Disease, outlines the rationale for such an approach and addresses perceived disadvantages, limitations and barriers. Priority actions and suggestions for how these can best be applied in practice are proposed.