Background and challenges to implementation:
Few studies in India have investigated whether face to face counseling sessions with follow-up can increase quit rates of tobacco, and whether this strategy is feasible and effective for promoting tobacco cessation is still unclear in Indian settings. We conducted a study to test the real world effectiveness of behavioral counselling on tobacco cessation among a cluster of tobacco users. This paper highlights key findings from the same study.

Intervention or response:
We compared the quit rates of one group which received brief face-to-face counseling (FC) alone (one session of 1-3 minutes) to another group which received the same face-to-face counseling plus 3 follow-up sessions (FCF) of face-to-face counseling (3-5 min each) at 1 week, 1 and 3 month follow-up, using a non-randomized controlled study. From March 2016 to October 2016, tobacco users who sought treatment in primary care settings of two high tobacco burden states in India were invited to participate in the study. Eligible tobacco users (N =535) were divided into two groups: FC (n=132) and FCF (n=394). Main outcomes was self-reported abstinence at 3 month follow-up.

Results and lessons learnt:
By intention to treat, at 3 month follow-up, the quit rates of FC and FCF were 21 % and 31 %, and respectively. Chi-square test showed that there was significant association between type of intervention and quit rate. The odds of quitting was 1.7 (95% CI 1.1, 2.7; P< 0.05) times higher in the FCF group compared to the FC group.

Conclusions and key recommendations:
To the best of our knowledge, we have provided the first evidence in India that additional follow-up sessions can increase the effectiveness of a face-to-face counseling session and can be adopted in routine clinical practices. This data should be used to leverage further work and expansion to other districts and states of the country.