Background and challenges to implementation:
Despite their proven value, tobacco dependence treatment (TDT) services are short in the Eastern Mediterranean Region (EMR) partly due to the lack of expertise among healthcare providers (HCPs). Since training is a proven strategy to avail TDT, King Hussein Cancer Center (KHCC) trained 2,000 HCPs in EMR (between 2011 and 2016). However, centralization meant limited training capacity, calling for scaling up.

Intervention or response:
KHCC collaborated with institutions in Oman, Egypt, Tunisia, and Morocco to build sustainable evidence-based local training hubs. The collaborating institutions host and manage the hubs. (1) In each country, needs were assessed to inform identification of target audiences, program design, and selection of HCPs to serve as trainers; and relevant system-level barriers and facilitators were scanned. (2) KHCC shared its evidence-based training curriculum with hubs for translation and necessary customization. (3) KHCC held training of trainers (ToT) workshops, observed trainers in action, and provided feedback. The ToT workshops provided an opportunity for the group of trainers to reflect on barriers and plan action for a TDT-supporting environment.

Results and lessons learnt:
84 HCPs were engaged as trainers (all non-smokers and mostly clinicians). Results from two rounds of semi-annual post-ToT online follow up indicate trainer engagement (Table 1). Respondents report the need for strengthened TDT clinical experience as a barrier to engaging in training, and administrative issues and shortage of medications as barriers to practice.

[Table 1]

Within the first year of launching, the hubs offered 8 training workshops through their local trainers (almost double KHCC's historical capacity of 4.5 workshops). Hubs also report miscellaneous TDT awareness activities, and TDT advocacy work.

Conclusions and key recommendations:
Our program succeeded in expanding the availability of TDT training and in building a network of trainers/advocates. Yet, hubs need to strengthen their advocacy role to address barriers holding them from achieving full potential, such as those preventing some trainers from engaging in training.