Introduction:
Aim: Tuberculosis and smoking are two colliding epidemics which independently pose a significant threat to global health. There is consistent epidemiological evidence of the association between smoking and TB. This study aims to investigate Armenian TB physicians’ perceptive on the association between smoking and TB treatment.

Methods:
The study team implemented the qualitative study through in-depth interviews (IDIs) and focus group discussions (FGDs) with TB physicians. Study participants were from in-patient and outpatient healthcare settings from Yerevan (the capital city), Syunik and Gegharkunik marzes. Semi-structured guides were used for moderating the IDIs and FGDs. The snowball sampling technique was utilized to identify 21 TB physicians.

Results:
The overwhelming majority of TB physicians knew about the influence of smoking on TB treatment and agreed that TB patients need to quit smoking. Improved TB treatment outcomes, accelerated recovery, and decreased risk of TB relapse were identified as the most common positive effects of smoking cessation among TB patients. Some physicians mentioned other benefits of quitting smoking which were not directly linked to TB treatment, such as improved health outcomes related to non-communicable diseases, improved metabolism, and stronger immune system. However, a few TB physicians were skeptical about smoking adversely affecting the TB treatment process and outcomes. They commented on the shortage of statistical data supporting the direct effect of smoking and the perception that smoking harms the body but does not specifically impede the process of TB treatment demonstrating their doubts regarding the adverse effects of smoking.

Conclusions:
The acknowledgment of negative association of smoking on TB treatment process and outcomes could facilitate provision of smoking cessation interventions by TB physicians and ultimately address the dual burden of TB and tobacco in Armenia.

Funding:
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.