Zili: Published in: SpaceTechVision Journal, Volume 7, Issue 1 April 2025
DOI: 10.1234/spacetech.2025.07.001
Keywords: Tuberculosis (TB); Human Immunodeficiency Virus (HIV); People Living with HIV (PLHIV); Tobacco Smoking;
Smoking Prevalence; Smoking Cessation; Eastern Mediterranean Region; Jordan; Public Health; Cross-sectional Study;
Sociodemographic Factors; Multivariable Logistic Regression; Health Behavior; Knowledge Attitude Practice (KAP) Survey
ABSTRACT
INTRODUCTION: Treatment failure due to ongoing smoking in TB patients and PLHIV results in undesirable outcomes. Precise estimates of smoking prevalence are lacking in the Eastern Mediterranean Region, where HIV and TB also have low and highly variable prevalences. Prevalence of current smoking among TB patients and PLHIV and factors linked with current smoking among them in Jordan were evaluated by this research.
METHODS: We analyzed data from the Jordan Knowledge, Attitude, and Practices survey in 2021. Information on current tobacco use, including products and how often they smoked, was obtained from 452 TB patients and 152 PLHIV. Multivariable logistic regression was used to examine the sociodemographic factors independently related to current smoking.
RESULTS: Current smoking prevalence was 43.8% among PLHIV and 67.8% among TB patients, with conventional cigarettes being the most smoked tobacco products. Current smoking prevalence among TB patients was more prevalent among males (AOR=8.20; 95% CI: 5.05–13.32), Jordanians (AOR=5.37; 95% CI: 2.66–10.86), and Syrians (AOR=4.13; 95% CI: 1.60–10.67), and among individuals with financial constraints (AOR=2.83; 95% CI: 1.69–4.74). Prevalence of current smoking among PLHIV was greater in those experiencing financial problems (AOR=3.13; 95% CI: 1.19–8.27).
CONCLUSIONS: Almost half of the TB patients and PLHIV were current smokers, more than the general population. It is a pressing need to explore the causes for such a high prevalence of smoking and to initiate and enhance smoking cessation services within the TB and HIV control programs.
INTRODUCTION:
Smoking, tuberculosis (TB), and human immunodeficiency virus (HIV) infection continue to remain among the three most important public health issues in the world. WHO approximates that over 20% of worldwide TB burden in 2020 could be caused by smoking tobacco and estimates to account for an extra 18 million cases of TB in 2050. There has been evidence produced to prove that smoking accelerates the manifestations of TB as well as raises the likelihood of drug resistance, TB relapse, and unsuccessful treatment outcomes for TB, including mortality. Secondly, exposure to secondhand smoke will also considerably raise the risk of TB infection and TB disease among the families and the household contacts of TB patients.
Smoking tobacco is also risky for PLHIV since smokers have a higher chance of developing cardiovascular disease (CVD), malignant neoplasms, chronic obstructive pulmonary disease (COPD), and severe HIV-related infections such as bacterial pneumonia compared to non-smokers. Smokers also have a better chance of experiencing a worse HIV treatment response, a higher likelihood of acquiring a life-threatening condition, and a lower life expectancy than PLHIV who are non-smokers. In addition, the years of life lost on average in smokers with HIV have been calculated at 12 years, which is over two times the years lost due to HIV infection alone.
Middle Eastern countries are witnessing a smoking epidemic. The Eastern Mediterranean Region (EMR) is one of two WHO regions with the highest-growing consumption of tobacco products, where tobacco use prevalence is predicted to rise by 25% by 2025 compared with a decline in Asia, North America, and Europe. The prevalence of tobacco consumption in Jordan is 65.3% for males and 16.4% for females, one of the world’s largest tobacco users in 2019. The rate of women smokers has risen by 4% over ten years, to the levels of Western nations.
Jordan has significantly contributed to the enhancement of TB and HIV treatment services, and is a low TB and HIV burden nation, with a TB incidence rate of 4 per 100000 population and an HIV prevalence rate of 0.02% in the general population. Nevertheless, the TB and HIV burden is limited to some specific high-risk risk groups such as economic migrants from high TB burden Asian and African countries, as well as refugees from the adjacent conflict-ridden nations. Past research has indicated a high rate of tobacco smoking among TB and HIV populations in highly affected countries, but the current status regarding tobacco consumption among PLHIV and TB patients is not available in Jordan. This study will assist TB and HIV programs to evaluate whether tobacco smoking impacts the best TB and HIV treatment outcomes and incorporate tobacco cessation services into treatment services within both programs. In this regard, this study was conducted to find the prevalence of current tobacco smoking among TB and PLHIV patients and to assess the sociodemographic characteristics associated with current smoking among TB and PLHIV.
METHODS: We did a cross-sectional analysis using data on tobacco consumption obtained from part of the Knowledge, Attitude, and Practice (KAP) survey. This research was supported by the International Organization for Migration (IOM) with funding from the Global Fund and carried out by the Eastern Mediterranean Public Health Network (EMPHNET) research team using a semi-structured questionnaire. Convenience sampling was utilized to recruit participants and the response rate was 99%. The number of TB and PLHIV patients chosen during the study period is the overwhelming majority of patients on treatment in 2021. The KAP survey was translated into Arabic via the backward–forward translation method by two bilingual experts. Interviews were done face-to-face or over the telephone.
The KAP survey recruited all the new, unique TB patients (N=452) from nine TB health facilities in Amman, Mafraq, Irbid, and Zarqa between June to September 2021. Half of the unique PLHIV (N=152) who attended voluntary counselling and testing (VCT) clinic for follow-up and antiretroviral treatment (ART) were recruited between April to September 2021.
National TB and HIV programs: Jordan’s National Tuberculosis Program (NTP) embraced WHO’s DOTS strategy in the mid-1990s. The program is organized into three levels: a national unit in Amman, regional governorate-level centers, and peripheral health centers. TB diagnosis and treatment, including among non-nationals, are offered for free.
The National AIDS Program (NAP), which was set up under the Ministry of Health since the first case in 1986, has been developing its strategic plans over the years, ranging from the HIV/AIDS Strategy 2005–2009 to the NSP 2012–2016. Following a hiatus, an updated national response strategy was formulated in 2021. Free HIV care, including ART, has been available since 2003, mainly through Amman’s Care and Treatment Centre.