Barriers to integrating tobacco cessation treatment into tuberculosis DOT services: Perspectives of providers in Ibadan, Southwestern Nigeria

Background Tobacco use adversely affects tuberculosis (TB) outcomes, increasing the risks of treatment failure, disease progression, recurrence, and mortality. Integrating tobacco cessation treatment into directly observed therapy (DOT) services provides an opportunity to support patients with TB who smoke. However, DOT providers may face multiple barriers to delivering cessation interventions in routine practice. This study explored barriers to the delivery of tobacco cessation treatment by DOT providers in designated facilities in Ibadan, Southwestern Nigeria. Methods In-depth interviews were conducted with 12 DOT providers purposively recruited from DOT-designated facilities across six local government areas in Ibadan, Oyo State, Nigeria. Interviews were transcribed and analysed thematically to identify barriers to the delivery of tobacco cessation treatment within routine DOT services. Results Five major themes emerged. First, personnel-related barriers, including inadequate training, staff shortages, and heavy workloads, constrained providers’ capacity to deliver cessation support. Second, facility-level limitations included inadequate space for private counselling and limited availability of educational materials and clinical guidelines. Third, insufficient institutional funding restricted cessation-related activities, including patient home visits. Fourth, patient-related factors, particularly attitudes towards smoking cessation, presented additional challenges. Fifth, tobacco vendors were reported to interfere with cessation efforts. Providers described instances in which vendors maintained contact with patients, visited them, and, in some cases, paid patients’ bills to preserve customer relationships, potentially undermining attempts to quit smoking. Conclusions The delivery of tobacco cessation treatment within DOT services is constrained by interconnected provider-, facility-, institutional-, patient-, and community-level barriers. Tobacco cessation should be integrated as a funded component of routine TB care, supported by provider training, appropriate guidelines and educational materials, adequate resources for cessation activities, and stronger measures to address tobacco-industry and vendor practices that may undermine cessation efforts.