Gaps in tuberculosis control in Armenia: How to improve the care system?

Abstract

Introduction: Tuberculosis (TB) continues to be a global public health problem. People with weakened immune systems are more vulnerable to TB. It is one of the top 10 causes of death worldwide and is a leading cause of death for people living with HIV (PLWH). The aim of the current study was to perform programmatic data analysis of TB cases treated with the first-line drugs, registered in Armenia for the period of January 2017 - August 2018, and to identify gaps in TB care system in Armenia.

Methodology: A retrospective cohort study using programmatic data from National TB Program.

Results: Overall treatment success rate for the period of study was 79%. HIV had impact only on "died" outcome with odds ratio (OR) of 20.9. More than a third (34%) of all HIV-positive patients died during TB treatment and 45% of patients who had non-Armenian citizenship were lost to follow-up during the treatment (OR = 3.3). Treatment duration for the 8% of all cases (mainly with brain or bone localization) was > 9 months and lasted up to 500 days.

Conclusions: Better collaboration and partial integration of TB and HIV services in Armenia is required. The access to care for non-Armenian citizens needs to be improved. The national TB treatment guideline needs to be updated based on scientific evidence. This study demonstrates that continuous analysis of the available data and tailoring of the system is required to address the needs of key populations and achieve universal care coverage.

Keywords: Armenia; PLWH; People living with HIV; TB treatment outcomes; migrants; tuberculosis.