SCIMITAR

South Asia Programme to Address Tobacco-Related Multiple Long-Term Conditions in Severe Mental Illness (SCIMITAR-SA)  is a regional implementation research project funded by the UK’s National Institute for Healthand Care Research  (NIHR). The initiative targets tobacco use among individuals with Severe Mental Illness (SMI) in Pakistan, India, and Bangladesh, a group with markedly reduced life expectancy due in large part to
preventable conditions linked to tobacco. SCIMITAR SA adopts and tests a culturally sensitive, evidence based behavioural support intervention for cessation of both smoking and smokeless tobacco products in this vulnerable population. The intervention model builds on successful trials in South Asia and the UK. Findings from earlier trials indicate improved quit rates among SMI patients receiving structured behavioural support compared to usual care, demonstrating both clinical effectiveness and feasibility in low-resource settings. The SCIMITAR- SA will consist of structured counselling sessions, visual flipbooks, very brief advice  (Ask, Advise, Act), and trained healthcare providers who offer personalised support. The current study is a multi country, pragmatic randomised controlled trial with a total sample size of approximately
1450 participants across five sites— including Karachi and Rawalpindi in Pakistan, Dhaka and Bogura in Bangladesh, and Bangalore in India. Participants will be followed up for biochemically verified continuous abstinence at six months post-randomisation.