Armenia-US Collaboration to Address Chronic Disease via Education in Social Determinants Science (ACCESS)

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SUMMARY/ABSTRACT The COVID-19 pandemic heightened awareness of health disparities and related social determinants (SDs) globally, as well as inequalities in countries’ capacities to study and address such disparities and their SDs. This is especially relevant to non-communicable diseases (NCDs), which account for >70% of deaths annually and disproportionately impact low- and middle-income countries (LMICs). Armenia (AM) faces particular NCD- related challenges; NCDs account for 93% of all deaths and the top 10 causes of death, premature death, and disability. Critical to decreasing NCD burden is reducing modifiable NCD risk factors (e.g., tobacco/alcohol use, unhealthy diet); this is particularly important in AM. AM has the 11th highest male smoking rate globally (52%), ranks in the top 40% of countries in alcoholism rates, and has a 48% prevalence of overweight/obesity. SDs (e.g., healthcare, social context) impact both modifiable NCD risk factors and NCD outcomes, and play a crucial role in NCD-related health disparities in AM. We propose the Armenia-US Collaboration to Address Chronic Disease via Education in Social Determinants Science (ACCESS) program, in response to PAR- 21-230. Its overall goal is to reduce the NCD burden in AM by enhancing research capacity related to NCD prevention and control, emphasizing SDs of NCD risk factors as key components. ACCESS is a strategic collaboration between George Washington University (GW) and American University of Armenia (AUA), alongside AM’s Ministry of Health (MOH) and its entities (e.g., NIH). Leveraging our team’s substantial ongoing collaborations, ACCESS will be an effective, sustainable program that enhances research infrastructure, training, and research opportunities related to NCD prevention and control for junior researchers. In Aim 1, we will develop a formal NCD prevention and control research training program (emphasizing SDs of NCD risk factors) and related institutional infrastructure. We will offer specialized training to: a) long-term MPH trainees who already hold an MD or related doctoral degree in order to develop future NCD research leaders; and b) short-term trainees (e.g., public health/clinical students/professionals) to enhance core NCD research skills. In Aim 2, we will advance AM’s national NCD research agenda via mentored research focused on SDs of NCD risk factors among future NCD research leaders (i.e., long-term trainees). In Aim 3, we will catalyze NCD- related research dissemination and knowledge translation to inform policy and practice, by enhancing related skills and leveraging the engagement of the MOH and its entities. ACCESS will be the 1st program of its kind in AM and will address AM’s national health priorities. We will establish future NCD prevention and control leaders and an educational core for the broader community of public health and clinical professionals in AM. Our team is uniquely-suited to establish ACCESS, enhance NCD research capacity in AM in the next 5 years, and sustain and expand it in scope and scale in the long-term to optimize its impact on global NCD burden.