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Combating Two Global Epidemics: Tobacco Dependence Treatment Trainings for TB Physicians

The American University of Armenia (AUA) Turpanjian School of Public Health’s Avedisian Onanian Center for Health Services Research and Development (CHSR) with support from Global Bridges and Pfizer Independent Grants for Learning and Change (IGLC) continues  to expand its work in the field of tobacco dependence treatment by addressing tobacco use among tuberculosis (TB) patients. In the scope of the two-year project “Integrating evidence-based tobacco control services into tuberculosis control in Armenia,” the CHSR aims to design, implement, and evaluate an advocacy and training program for integrating tobacco control measures into TB control in Armenia.

Among former Soviet countries, Armenia was the first to accede to the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in November 2004. Soon afterwards, Armenia adopted a national tobacco control law to ban smoking in healthcare, education, culture facilities, and public transport. The FCTC Article 14 states that “All health-care workers should be trained to ask about tobacco use, record it in the notes, give brief advice on stopping, and direct tobacco users to the most appropriate and effective treatment available locally.” However, inadequate training on tobacco dependence and its treatment has been one of the major obstacles to getting effective treatment of tobacco dependence in Armenia that is necessary for bringing down the smoking rates. This important project helps to further address this obstacle.

TB and smoking are two colliding epidemics which independently pose a significant threat to global health. Consistent epidemiological evidence demonstrates the negative effects of tobacco use on TB infection, progression of disease, TB relapse and mortality. The potential for improving TB treatment outcomes, prevention of recurrence of disease and deaths suggests the urgency of incorporating evidence-based tobacco control strategies into TB care.

The CHSR conducted a series of evidence-based tobacco dependence treatment trainings for 91 TB physicians from Armenia and Artsakh to address the deadly pairing of TB and smoking. The research team developed the training materials based on the evidence-based international resources and adapted them to the local context. The training program focused on such topics as tobacco epidemics, neurobiology of nicotine addiction, and the role of healthcare professionals in smoking cessation. In addition, it included motivational interviewing, pharmacotherapy for smoking cessation, relapse prevention, as well as an introduction to the national joint TB and tobacco control strategy recently launched in Armenia. The Ministry of Health of the Republic of Armenia (RA) accredited the two-day training curriculum and designated eight continuing medical education (CME) credits. The trainings were conducted by Arusyak Harutyunyan, MD, MPH, senior researcher and primary investigator of the project; Zaruhi Grigoryan, BS, MPH, research associate; and Anush Khachatryan, the Head of the Monitoring and Evaluation Department of the National Tuberculosis Control Center (NTCC). Dr. Arusyak Harutyunyan is the only expert in Armenia that has the Mayo Clinic’s Tobacco Treatment Specialist Certificate.

Dr. Arsen Torosyan, RA Minister of Health, Dr. Armen Hayrapetyan, the Head of the NTCC, Dr. Aleksandr Bazarchyan, the Head of the National Institute of Health (NIH), and Dr. David Petrosyan, Advisor to the Minister of Health, visited one of the trainings in Tsakhkadzor. Minister Torosyan stated: “Smoking cessation is an urgent need for all smokers, specifically for those suffering from smoking-induced diseases like TB. We need to follow the international practice regarding the physician’s role in smoking cessation ‒ they should provide assistance in smoking cessation rather than only advising smokers to quit.” The Minister’s interview along with the highlights from the trainings were featured on “The Dr. David Medical TV Show” broadcasted on Kentron TV (minutes 6:05-13:27) that was devoted to the celebration of World No Tobacco Day 2018.

The AUA Gerald and Patricia Turpanjian School of Public Health works actively to improve population health and health services in Armenia and the region through interdisciplinary education and development of public health professionals to be leaders in public health, health services research and evaluation, and health care delivery and management.