Aim and objective:
The deadly pairing of tuberculosis (TB) and tobacco use has been widely acknowledged as a major public health concern. The negative effects of tobacco use on TB infection, progression of disease, TB relapse and mortality are supported with consistent epidemiological evidence. The potential of addressing TB treatment outcomes, recurrence of disease and prevention of deaths rationalizes the urgency of incorporating evidence-based tobacco control strategies into TB care. In this study we aimed to investigate the challenges and opportunities for integrating tobacco dependence treatment into TB care in Armenia.

Methods:
Qualitative research methodologies were applied to study the existing smoking cessation practices within TB care among TB physicians and experts in the field of TB and tobacco control. Overall, 21 TB physicians (in-patient and out-patient) and 5 experts from Yerevan (the capital city), Syunik, Kotayk and Gegharkunik regions of Armenia were recruited to participate in 4 focus group discussions and 10 in-depth interviews lead by semi-structured interview guides.

Results:
Study participants shared their insights on potential opportunities and challenges for initiating smoking cessation interventions among TB patients. The diagnosis of TB that serves as a key teachable moment, continuous patient-provider encounters, and mutual trust between patients and TB physicians were mentioned as factors that can enable provision of smoking cessation counseling with TB patients. As for the participants, patients’ psychological distress because of the diagnosis, long and stressful treatment of disease, withdrawal symptoms and non-acceptance of pharmacological tobacco dependence treatment can challenge the provision of smoking cessation counseling to TB patients.

Conclusions:
Despite the evident opportunities that exist for engaging TB patients into smoking cessation counseling in Armenia, the implemented measures of joint TB and tobacco control can be effective, once the all existing challenges are acknowledged and addressed.

Funding statement:
The study was supported by the Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, hosted by Mayo Clinic and Pfizer Independent Grants for Learning and Change.