{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T13:35:54Z","timestamp":1767792954328,"version":"3.49.0"},"reference-count":44,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"unspecified","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100032626","name":"Unitaid","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100032626","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["R03AI180576"],"award-info":[{"award-number":["R03AI180576"]}],"id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R008345\/1"],"award-info":[{"award-number":["MR\/R008345\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Resp Res"],"accepted":{"date-parts":[[2025,11,27]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>People who smoke are at increased risk of unfavourable tuberculosis treatment outcomes compared with those who do not, but the pathways that explain this disparity are unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To estimate the difference in a successful end-of-treatment outcome by smoking status among people with multidrug- or rifampicin-resistant tuberculosis (MDR\/RR-TB) and to examine if this difference changes if people who smoked had the same retention in treatment as those who did not smoke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and methods<\/jats:title>\n                    <jats:p>Using data from the prospective endTB Observational Study, we estimated the difference in treatment success by cigarette smoking status, adjusting for baseline confounders including demographics, social history and comorbidities. To examine how this difference changed if everyone was retained in treatment, we censored participants who were lost to follow-up and applied inverse probability of censoring weights to simulate this scenario.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1786 participants in 12 countries, 539 (30.2%) reported smoking at least one cigarette daily. People who smoked were more frequently found in post-Soviet countries and had a complex social history (eg, incarceration and substance use) and infectious comorbidities (eg, hepatitis C). At the end of treatment, 73.5% of people who smoked and 80.3% of people who did not smoke had treatment success (risk difference in percentage points: \u22126.8, 95% CI \u221211.1 to \u20132.6). After adjusting for baseline confounders, the risk difference was similar (\u22125.2\u2009percentage points), but the 95%\u2009CI was less precise (\u221214.1 to 3.2). When simulating a scenario in which everyone was retained in treatment, the risk difference was attenuated (\u22121.9\u2009percentage points; 95%\u2009CI \u221211.1 to 4.7).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>People who smoked had a lower frequency of MDR\/RR-TB treatment success than those who did not smoke. Eliminating loss to follow-up reduced this difference by smoking status, suggesting that pathways related to retention in treatment were a major driver of this disparity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjresp-2025-003777","type":"journal-article","created":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T09:30:20Z","timestamp":1766655020000},"page":"e003777","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of smoking on drug-resistant tuberculosis treatment outcomes and potential mechanistic pathways: a multicountry cohort study"],"prefix":"10.1136","volume":"12","clinical-trial-number":[{"clinical-trial-number":"nct03259269","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3038-0644","authenticated-orcid":false,"given":"Matthew L","family":"Romo","sequence":"first","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"LaHood","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4022-3447","authenticated-orcid":false,"given":"Helen R","family":"Stagg","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carole D","family":"Mitnick","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA"},{"name":"Partners In Health, Boston, Massachusetts, USA"},{"name":"Division of Global Health Equity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Letizia","family":"Trevisi","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathy","family":"Hewison","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shrivani","family":"Padayachee","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Durban, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8869-4403","authenticated-orcid":false,"given":"Edwin","family":"Herrera Flores","sequence":"additional","affiliation":[{"name":"National Hospital Arzobispo Loayza, Lima District, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lawrence","family":"Oyewusi","sequence":"additional","affiliation":[{"name":"Partners In Health, Maseru, Lesotho"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Palwasha Y","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK"},{"name":"Interactive Research & Development, Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helena","family":"Huerga","sequence":"additional","affiliation":[{"name":"Epicentre, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathieu","family":"Bastard","sequence":"additional","affiliation":[{"name":"Epicentre, Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L","family":"Rich","sequence":"additional","affiliation":[{"name":"Partners In Health, Boston, Massachusetts, USA"},{"name":"Division of Global Health Equity, Brigham and Women\u2019s Hospital, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Girum Bayissa","family":"Tefera","sequence":"additional","affiliation":[{"name":"Partners In Health, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmud","family":"Rashitov","sequence":"additional","affiliation":[{"name":"Partners In Health, Almaty, Kazakhstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ohanna","family":"Kirakosyan","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Yerevan, Armenia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6417-2738","authenticated-orcid":false,"given":"Aga","family":"Krisnanda","sequence":"additional","affiliation":[{"name":"Interactive Research & Development, Jakarta, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atyrkul","family":"Toktogonova","sequence":"additional","affiliation":[{"name":"National Tuberculosis Center, Bishkek, Kyrgyzstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Rafi","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Institute of Chest Diseases, Kotri, Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camilo","family":"G\u00f3mez-Restrepo","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Yangon, Myanmar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tina","family":"Kotrikadze","sequence":"additional","affiliation":[{"name":"M\u00e9decins Sans Fronti\u00e8res, Tbilisi, Georgia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Molly F","family":"Franke","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,12,25]]},"reference":[{"key":"2026010701521942000_12.1.e003777.1","unstructured":"World Health Organization . Global tuberculosis report 2024. 2024. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240101531"},{"key":"2026010701521942000_12.1.e003777.2","unstructured":"World Health Organization . WHO global report on trends in prevalence of tobacco use 2000-2025, fourth edition. 2021. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240039322"},{"key":"2026010701521942000_12.1.e003777.3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.puhe.2020.07.031","article-title":"Association between indoor air pollution, tobacco smoke and tuberculosis: an updated systematic review and meta-analysis","volume":"187","author":"Obore","year":"2020","journal-title":"Public Health (Fairfax)"},{"key":"2026010701521942000_12.1.e003777.4","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.1093\/aje\/kwy081","article-title":"Contribution of Smoking to Tuberculosis Incidence and Mortality in High-Tuberculosis-Burden Countries","volume":"187","author":"Amere","year":"2018","journal-title":"Am J Epidemiol"},{"key":"2026010701521942000_12.1.e003777.5","first-page":"430","article-title":"Clinical and epidemiological aspects of smoking and tuberculosis: a study of 13,038 cases","volume":"9","author":"Altet-G\u00f4mez","year":"2005","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026010701521942000_12.1.e003777.6","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.20-0424"},{"key":"2026010701521942000_12.1.e003777.7","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00114214"},{"key":"2026010701521942000_12.1.e003777.8","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.19.0002"},{"key":"2026010701521942000_12.1.e003777.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0239333","article-title":"Effect of smoking on tuberculosis treatment outcomes: A systematic review and meta-analysis","volume":"15","author":"Burusie","year":"2020","journal-title":"PLoS One"},{"key":"2026010701521942000_12.1.e003777.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijtb.2023.04.010"},{"key":"2026010701521942000_12.1.e003777.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2023.08.021"},{"key":"2026010701521942000_12.1.e003777.12","doi-asserted-by":"crossref","DOI":"10.18332\/tid\/123845","article-title":"Smoking increases the risk of infectious diseases: A narrative review","volume":"18","author":"Jiang","year":"2020","journal-title":"Tob Induc Dis"},{"key":"2026010701521942000_12.1.e003777.13","doi-asserted-by":"crossref","DOI":"10.1183\/16000617.0252-2021","article-title":"No smoke without fire: the impact of cigarette smoking on the immune control of tuberculosis","volume":"31","author":"Quan","year":"2022","journal-title":"Eur Respir Rev"},{"key":"2026010701521942000_12.1.e003777.14","doi-asserted-by":"crossref","unstructured":"Stagg HR , Flook M , Martinecz A , et al . All nonadherence is equal but is some more equal than others? Tuberculosis in the digital era. ERJ Open Res 2020;6. doi:10.1183\/23120541.00315-2020","DOI":"10.1183\/23120541.00315-2020"},{"key":"2026010701521942000_12.1.e003777.15","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-16259-6","article-title":"Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient\u2019s perspective","volume":"23","author":"Appiah","year":"2023","journal-title":"BMC Public Health"},{"key":"2026010701521942000_12.1.e003777.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0203937","article-title":"\u201cTreatment is of primary importance, and social assistance is secondary\u201d: A qualitative study on the organisation of tuberculosis (TB) care and patients\u2019 experience of starting and staying on TB treatment in Riga, Latvia","volume":"13","author":"Kielmann","year":"2018","journal-title":"PLoS One"},{"key":"2026010701521942000_12.1.e003777.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-12005-y","article-title":"Barriers and strategies to successful tuberculosis treatment in a high-burden tuberculosis setting: a qualitative study from the patient\u2019s perspective","volume":"21","author":"Pradipta","year":"2021","journal-title":"BMC Public Health"},{"key":"2026010701521942000_12.1.e003777.18","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00353-2018","article-title":"Analysis of loss to follow-up in 4099 multidrug-resistant pulmonary tuberculosis patients","volume":"54","author":"Walker","year":"2019","journal-title":"Eur Respir J"},{"key":"2026010701521942000_12.1.e003777.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0281918","article-title":"Vulnerability and tuberculosis treatment outcomes in urban settings in England: A mixed-methods study","volume":"18","author":"Berrocal-Almanza","year":"2023","journal-title":"PLoS One"},{"key":"2026010701521942000_12.1.e003777.20","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.19.0080"},{"key":"2026010701521942000_12.1.e003777.21","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.22.0678"},{"key":"2026010701521942000_12.1.e003777.22","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-024-09417-7","article-title":"Predictors of unsuccessful tuberculosis treatment outcomes in Brazil: an analysis of 259,484 patient records","volume":"24","author":"Ryuk","year":"2024","journal-title":"BMC Infect Dis"},{"key":"2026010701521942000_12.1.e003777.23","unstructured":"World Health Organization . WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-resistant tuberculosis treatment. 2022. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240063129 [Accessed 10 Jan 2025]."},{"key":"2026010701521942000_12.1.e003777.24","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00495-2019","article-title":"Quality of life, tuberculosis and treatment outcome; a case-control and nested cohort study","volume":"56","author":"Datta","year":"2020","journal-title":"Eur Respir J"},{"key":"2026010701521942000_12.1.e003777.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2018.07.007"},{"key":"2026010701521942000_12.1.e003777.26","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-47094-9","article-title":"Economic burden of multidrug-resistant tuberculosis on patients and households: a global systematic review and meta-analysis","volume":"13","author":"Akalu","year":"2023","journal-title":"Sci Rep"},{"key":"2026010701521942000_12.1.e003777.27","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-018-23344-z","article-title":"Comorbidities and treatment outcomes in multidrug resistant tuberculosis: a systematic review and meta-analysis","volume":"8","author":"Samuels","year":"2018","journal-title":"Sci Rep"},{"key":"2026010701521942000_12.1.e003777.28","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-019-4378-4","article-title":"The endTB observational study protocol: treatment of MDR-TB with bedaquiline or delamanid containing regimens","volume":"19","author":"Khan","year":"2019","journal-title":"BMC Infect Dis"},{"key":"2026010701521942000_12.1.e003777.29","unstructured":"endTB Consortium . Clinical and programmatic guide for patient management with new TB drugs. Version 4.0. 2018. Available: https:\/\/endtb.org\/sites\/default\/files\/2018-04\/Guide%20for%20New%20TB%20Drugs%20Version%204.0.pdf [Accessed 13 Jan 2025]."},{"key":"2026010701521942000_12.1.e003777.30","doi-asserted-by":"crossref","unstructured":"Law S , Fulcher I , Ashraf S , et al . Characterizing treatment adherence trajectories in the endTB multisite cohort of drug-resistant tuberculosis patients: an application of group-based trajectory modelling. Clin Infect Dis 2025:ciaf467. doi:10.1093\/cid\/ciaf467","DOI":"10.1093\/cid\/ciaf467"},{"key":"2026010701521942000_12.1.e003777.31","unstructured":"World Health Organization . Definitions and reporting framework for tuberculosis \u2013 2013 revision. 2013. Available: https:\/\/www.who.int\/publications\/i\/item\/9789241505345 [Accessed 13 Jan 2025]."},{"key":"2026010701521942000_12.1.e003777.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.08.028"},{"key":"2026010701521942000_12.1.e003777.33","doi-asserted-by":"publisher","DOI":"10.1080\/00031305.2016.1154108"},{"key":"2026010701521942000_12.1.e003777.34","doi-asserted-by":"crossref","first-page":"887","DOI":"10.5588\/ijtld.16.0933","article-title":"What happened to patients with RMP-resistant\/MDR-TB in Zambia reported as lost to follow-up from 2011 to 2014?","volume":"21","author":"Kasapo","year":"2017","journal-title":"Int J Tuberc Lung Dis"},{"key":"2026010701521942000_12.1.e003777.35","doi-asserted-by":"publisher","DOI":"10.5588\/pha.21.0083"},{"key":"2026010701521942000_12.1.e003777.36","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.01030-2018","article-title":"Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: a systematic review","volume":"53","author":"Law","year":"2019","journal-title":"Eur Respir J"},{"key":"2026010701521942000_12.1.e003777.37","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(24)00816-8"},{"key":"2026010701521942000_12.1.e003777.38","doi-asserted-by":"publisher","DOI":"10.1136\/thoraxjnl-2020-215926"},{"key":"2026010701521942000_12.1.e003777.39","doi-asserted-by":"crossref","DOI":"10.7189\/jogh.14.04187","article-title":"Smoking cessation to prevent death and tuberculosis recurrence after treatment: A prospective cohort study with a seven-year follow-up in China","volume":"14","author":"Lin","year":"2024","journal-title":"J Glob Health"},{"key":"2026010701521942000_12.1.e003777.40","unstructured":"Integrated approach to tuberculosis and lung health: policy brief. Licence: CC BY-NC-SA 3.0 IGO. Geneva World Health Organization; 2025."},{"key":"2026010701521942000_12.1.e003777.41","unstructured":"World Health Organization . WHO clinical treatment guidelines for tobacco cessation in adults. 2024. Available: https:\/\/www.who.int\/publications\/i\/item\/9789240096431 [Accessed 16 Jan 2025]."},{"key":"2026010701521942000_12.1.e003777.42","doi-asserted-by":"crossref","DOI":"10.1186\/1747-597X-6-26","article-title":"The SCIDOTS Project: evidence of benefits of an integrated tobacco cessation intervention in tuberculosis care on treatment outcomes","volume":"6","author":"Awaisu","year":"2011","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"2026010701521942000_12.1.e003777.43","doi-asserted-by":"publisher","DOI":"10.5588\/pha.17.0085"},{"key":"2026010701521942000_12.1.e003777.44","doi-asserted-by":"publisher","DOI":"10.1093\/tbm\/ibz100"}],"container-title":["BMJ Open Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjresp-2025-003777","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T09:54:21Z","timestamp":1767779661000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopenrespres.bmj.com\/lookup\/doi\/10.1136\/bmjresp-2025-003777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":44,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12,25]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjresp-2025-003777"],"URL":"https:\/\/doi.org\/10.1136\/bmjresp-2025-003777","relation":{},"ISSN":["2052-4439"],"issn-type":[{"value":"2052-4439","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}