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Extensive Review of TB Prevention, Care and Control Services in Armenia

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The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Extensive Review of TB Iceland Ireland Israel Edited by: Masoud Dara Prevention, Care and Italy Kazakhstan Zaruhi Mkrtchyan Kyrgyzstan Control Services in Latvia Gayane Ghukasyan Lithuania Luxembourg Malta Armenia Monaco Montenegro Netherlands 21 April – 4 May 2011 Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan World Health Organization Regional Office for Europe ISBN Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark WHOLIS number Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: [email protected] Original: Web site: www.euro.who.int Mission Report Extensive Review of TB Prevention, Care and Control Services in Armenia 21 April – 4 May 2011 ii Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø, Denmark Alternatively complete online requests form for documentation, health information, or for permission to quote or translate, on the WHO/Europe web site at http://www.euro.who.int/pubrequest. © World Health Organization 2012 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The views expressed by authors, editors, or expert groups do not necessarily represent the decisions or the stated policy of the World Health Organization. Writing Committee Written by Masoud Dara, WHO Regional Office for Europe Andrei Dadu, WHO Regional Office for Europe Smiljka de Lussigny, WHO Regional Office for Europe Brenda van den Bergh, WHO Regional Office for Europe Alejandra Gonzalez Rossetti, WHO Regional Office for Europe Bert Schreuder, KNCV TB Foundation Askar Yedilbayev, Partners in Health Doris Hillemann, Supranational Reference Laboratory, Borstel Kristin Kremer, WHO Regional Office for Europe Nonna Turusbekova, KNCV TB Foundation Andre Zagorski, Management Sciences for Health With contributions from Diana Atajanyan, independent consultant Edited by Masoud Dara, WHO Regional Office for Europe Zaruhi Mkrtchyan, Independent consultant Gayane Ghukasyan, WHO Country Office in Armenia Acknowledgements The members of the mission would like to thank the Minister of Health of Armenia, Professor Kushkyan, for his timely request to the WHO Regional Office for Europe and for facilitating the extensive tuberculosis (TB) programme review. The following organizations and individuals contributed their valuable time, knowledge and experience to the extensive review of TB prevention, control and care in Armenia: − representatives of the Ministry of Health of the Republic of Armenia, acting on behalf of the Minister, Professor Kushkyan, and Deputy Minister, Dr Khachatryan; − heads of marz (provincial) health departments and TB coordinators in Gegharkunik, Kotayk and Lory marzes (provinces); − administration and staff of the Republican TB Dispensary, acting on behalf of Dr Marina Safaryan; − heads and staff of health-care facilities and TB services in Yerevan, Kotayk, Gegharkunik, Lory and Aragatsotn marzes; − heads and staff of the health-care unit of the criminal-executive department of the Ministry of Justice, criminal-executive institutions and the Central Hospital for Detainees; − representatives of the United States Agency for International Development (USAID)/Armenia mission, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and World Bank Project Implementation Unit, and Médecins Sans Frontières France. Contents Abbreviations ...................................................................................................................................... i Executive summary ............................................................................................................................ iii Key recommendations ........................................................................................................................ iv Background ......................................................................................................................................... 1 Epidemiology of TB in Armenia ............................................................................................................ 3 Organization and management ............................................................................................................ 6 Findings ....................................................................................................................................................... 7 Accountability, responsibility and institutional capacity......................................................................... 7 Stewardship ............................................................................................................................................. 8 Recommendations ...................................................................................................................................... 8 Financing .......................................................................................................................................... 10 Findings ..................................................................................................................................................... 10 Recommendations .................................................................................................................................... 11 Human resources development ......................................................................................................... 13 Findings ..................................................................................................................................................... 14 Recommendations .................................................................................................................................... 15 Management of TB medicines ........................................................................................................... 16 Findings ..................................................................................................................................................... 16 Selection ................................................................................................................................................ 16 Procurement .......................................................................................................................................... 17 Registration ........................................................................................................................................... 17 Distribution and storage ....................................................................................................................... 18 Recommendations .................................................................................................................................... 19 Diagnosis .......................................................................................................................................... 20 Findings ..................................................................................................................................................... 20 Case detection ....................................................................................................................................... 20 Intensified TB case-finding in people living with HIV ............................................................................ 20 HIV testing and counselling in TB patients and
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