In 10 years, Armenia managed to nearly halve the number of new tuberculosis (TB) patients and decrease the mortality by 4 times. “Our reforms were successful because they were fully supported by the Ministry of Health. We aimed at increasing successful treatments by reducing hospitalizations and ensuring the commitment of patients to treatment,” states Dr Armen Hayrapetyan, the Director of the National Centre for TB Control in Armenia and Manager of the National TB Control Programme.
Armenia is one the 18 countries in the WHO European Region with the highest burden of TB and multidrug-resistant TB (MDR-TB). In 2006, it adopted significant reforms that were implemented through the National TB Control Programme, with technical support from WHO. In 2007–2016, mortality fell from 8.6 to 2.1 per 100 000 people and the number of new cases decreased from 72 to 44 per 100 000.
In 2009, Armenia moved from a paper-based information system for TB patients to e-TB manager, an electronic information system, drawing on WHO recommendations. The e-TB manager allows every doctor to follow-up online on the treatment history of TB patients and therefore is particularly useful to track and ensure successful treatment for MDR-TB patients.
Hospitalization reduced by 60%
A few years later, in 2014, with WHO’s technical guidance and the support of national and international partners, Armenia scaled up implementation of people-centred care through more rational use of hospitals and better financing for ambulatory care. The previous system was grounded on the belief that hospitalization was necessary to ensure that TB patients completed their treatment, and that all people with TB are contagious. Actually, the hospitalization of people with TB or for diagnosis purposes increased the risk of transmission of TB and of acquiring resistance to antibiotics. The implementation of new policies led to a significant drop in TB-related hospital admissions: from 7000 in 2006 to 2700 in 2016, a reduction of nearly 60% in 10 years. They also significantly reduced the length and costs of hospitalization without affecting the rates of successful treatment.
New drugs for patients at no cost
The outpatient TB treatment policy was complemented in 2015 by piloting and then introducing new TB drugs, namely bedaquiline and delamanid, which are less toxic and more effective, especially for MDR-TB. The use of better drugs, following the WHO guidance for optimal uptake and responsible use of new TB drugs and regimens, was a major step for Armenia. The health system provides all medicines free of charge for patients, regardless of their citizenship, and thanks to better planning, shortages in drugs supply do not happen anymore.
Sustained political commitment
Government commitment is crucial to achieve significant results. In 2007, Armenia endorsed the Berlin Declaration “All against TB” and started substantial reforms of TB prevention and care. Today, the Armenian example can be a model for other countries in eastern Europe and central Asia that are engaged in ending TB.
WHO’s support to the above-mentioned TB reforms in Armenia was funded by the United States Agency for International Development (USAID).