1 global bridges pre-conference workshop dr lekan ayo-yusuf, dds, mph, phd african region srnt...
TRANSCRIPT
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Global BridgesPre-conference Workshop
Dr Lekan Ayo-Yusuf, DDS, MPH, PhD
African Region
SRNT preconference Meeting, Boston
March 13, 2013
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OBJECTIVE 3
To facilitate the implementation of Article 14 in every nation
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Develop national cessation guidelines
Article 14 states, “Each Party shall develop and disseminate appropriate, comprehensive and integrated guidelines based on scientific evidence and best practices, taking into account national circumstances and priorities, and shall take effective measures to promote cessation of tobacco use and adequate treatment for tobacco dependence”.
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Provision of the WHO FCTC Article 14
1. People – HPCs, traditional healers, community workers
2. Place – clinics, hospitals, schools and community centres
3. Practice: Brief advice and counselling for individuals Need: country-specific clinical guidelines (0%)Promote cessation – Integrate with other articles (synergism with e.g. 6, 8,11,12,13) - TC currently low level implementation
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The focus of Article 14 is to (1) encourage more people to make attempts to cease tobacco use and (2) utilise effective interventions to make the success of these attempts more likely
The priority for countries with low levels of tobacco control is to implement effective strategies to promote cessation and then to later provide TDT, starting with broad reach low cost interventions that, as far as possible, use existing infra-structure
Countries with an existing and strong tobacco control framework should •Focus on achieving full coverage of the basic approaches (e.g. brief advice to quit) within their healthcare systems and monitoring the impact of these•Work to improve the impact of TDT by ensuring greater reach and efficacy
A14 guideline: Stepwise approach
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Use opportunities for tobacco cessationProgrammes and settings to
promote tobacco cessation Media campaigns and local events
such as World No Tobacco Day (WNTD) activities (64% of 28 surveyed countries in 2011).
Quit-line (currently 1)– promote introduction of free services in Africa (leverage on mobile phones).
Integration of cessation services into various levels of the health-care systems and other articles (Hospitals & addiction services - ASSIST).
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Supporting demand reduction measures
Gambia & Togo to introduce a new tobacco taxation policy in January 2013
Congo’s Parliament adopted in July 2012 legislation containing provisions banning smoking in public places and the sales of tobacco products to minors, forbidding tobacco advertising, promotion and sponsorship, and calling for health warnings on tobacco packages
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Demand reduction measures (cont..) Senegal & Mauritius ran
campaign on effects of SHS to promote cessation (by WLF).
The Cameroon Coalition Against Tobacco in association with the regional WHO office, held a training for CSOs and members of the Public Administration on the implementation of WHO FCTC and issues of non-Communicable Diseases resulting from tobacco use.
Promote treatment as part of NCD control in partnership with CSO
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Integrative treatment for
tobacco use and dependence
PUBLIC AWARENESS POLICY SUPPORT
COUNSELLING
(start Brief advice)
MEDICATION
QUIT LINEAccessible
Affordable
Evidence-based
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OBJECTIVE 2
To provide state-of-the-art, evidence-based training in treatment and advocacy to network members
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Need to understand effect of policy synergies
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Prevalence of Current Programs
Countries respondingto survey (5 Afro countries)
Countries with a currentprogram
All C
ou
ntr
ies
Hig
h
Incom
eC
ou
ntr
ies
Mid
dle
In
com
eC
ou
ntr
ies
Low
In
com
eC
ou
ntr
ies
Afr
ican
Am
eri
cas
Easte
rnM
ed
iterr
an
ean
Sou
th E
ast
Asia
Weste
rnP
acifi
c
Eu
rop
ean
Income Level Geographic Region
Rigotti NA, Bitton A, et al. An international survey of training programmes for treating tobacco dependence. Addiction 2009 Feb;104(2):288-96.
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How Many People are Trained Each Year?
14,194 trained in 2007–5374 Americas–3759 Europe–3131 Western Pacific–1760 Southeast Asia– 98 Eastern Mediterranean– 72 Africa
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Why train healthcare professionals in MI
Motivational interviewing is one of the most cost-effective interventions in medicine
Key message = smoking is dangerous and it is worthwhile stopping
Motivate patient attempts at smoking cessation
Aimed at individual smokers and should be used by all health care professionals opportunistically
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Curriculum
Health effects of tobacco use Local and global (WHO FCTC) policy
initiatives for tobacco control Basics of nicotine dependence and
pharmacotherapy Basics of behavioural therapy for
tobacco use cessation Elements and principles of brief
Motivational Interviewing and strategies to elicit and respond to “change talk”
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Training in treatment and advocacy
Training follows level two of ATTUD provider proficiency and MI as the behavioural support strategy over 3 days–Day 1 - didactic teaching to provide knowledge, –Day 2 (one half of the group) and Day 3 (other half) - application of ‘skills’ through practice/role-play activities. Ends with a discussion on challenges and solutions to implementing what they have learned.
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Training in treatment and advocacy (cont.)
20-24 participants (MDs, nurses, dentists, counselors, physiotherapists, lay counsellors (doing HIV test counselling) etc.)
2-day trainings held: Nigeria (3 states), South Africa, Zambia, DRC, Uganda and Mauritius = 468 trainees
Future trainings: Tanzania, Ghana, Lesotho and South Africa
Also conduct a one-day programme for a larger audience at pre-conferences
–competency outcome of level one of ATTUD framework
South Africa (2 provinces), Ethiopia Upcoming: South Africa (Cape Town)
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Qualitative Results
Top-expectation of workshop:–To learn about MI–Smoking behaviour and Dx burden
What they liked most:–Role-plays
What they liked least:–Limited time to practice MI
Pre-course
Post-course
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Evaluation of training
Table 1: Changes in confidence levels to deliver MI following training
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6-months post training reports
Knowledge and skill transfer among peers through seminars, lecturing and publications in newsletters
Some developed proposals for tobacco cessation clinics and initiated projects
–Requests for financial assistance from GB: E.g. in DRC, they drafted a proposal for the integration of tobacco dependence treatment in Kitambo health zone in Kinshasa and would like to train HCPs–MoH would then replicate service
Most trainees reported that the knowledge and skills have improved their understanding of tobacco control issues and MI skills
Implementation challenges include not having enough time to effectively integrate MI in routine treatment, non-disclosure of smoking status by patients and lack of institutional support
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OBJECTIVE 1
To create and mobilize a global network of HCPs and organizations dedicated to advancing effective tobacco dependence treatment and advocating for effective tobacco control policy
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GB African Regional network – Countries represented:~50% of
the population
Africa
Morocco
Algeria
Angola
Benin
Botswana
BurkinaFaso
Burundi
Cameroon
CapeVerde
Central AfricanRepublic
Chad
Comoros
Djibouti
Egypt
EquatorialGuinea
Eritrea
Ethiopia
Gabon
The GambiaGhana
Guinea
Guinea-Bissau
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
MaliMauritania
Mauritius
Mozambique
Namibia
Niger
Nigeria
Rwanda
São Toméand Príncipe
Senegal
Sierra Leone
Somalia
SouthAfrica
Sudan
Swaziland
Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
DR Congo
Congo
Côted'Ivoire
<10%
10-19%
>=20%
No DataSeychelles
Prevalence estimates
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Conclusions The policy environment and the PHC systems
intervention, including quitline infrastructure in LMICs needs scaling up (<30% have basic Rx infrastructure).
We may need systems change at PHC to increase demand and take advantage of economies of scale in introducing medications at reduced cost e.g. EDL
Prioritize training medical students in treatment & raise awareness & training of other community health workers.