From the 24th – 26th September, a team of TB REP 2.0 project partners, representing TBEC and PAS Center took part in a three-day coaching visit to the Republic of Armenia.
The visit objective was to get acquainted with the overall context of the TB response in the country, with a specific focus on the capacity building needs of civil society organisations involved in TB care. To address such needs, a National Dialogue is planned in the future – to promote cooperation between NTP, other TB stakeholders, and civil society in advancing a people-centred approach to TB care. Further details regarding the National Dialogue will be made available on the TBEC website calendar. The coaching visit’s agenda included meetings with NTP, WHO CO, civil society organisations, organisations from affected communities, and Members of Parliament.
There are a number of positive signs regarding the response to TB in Armenia and the country has demonstrated particularly strong leadership in facilitating the timely introduction of new WHO DR-TB treatment guidelines. Within the remit of this change, Armenia is also transitioning to an entirely oral-treatment regime, rather than injectables. This is a great success; TBEC have been highlighting the need to provide TB patients with more manageable treatment regimes, rather than more toxic and less effective options for some time now and we are always pleased to see more countries making this change.
The political will to end TB in Armenia exists and MPs are working to raise the profile of the importance of TB at the National Assembly. In particular, Armenia is working to expand ambulatory models of care so that patients can receive treatment in more manageable conditions and with less disruption to their lives. It is a Champion country in the EECA region in this regard.
National stakeholders are already seeing the effectiveness of providing individual needs-based support to all patients undergoing TB treatment. This is encouraging adherence to treatment and reducing the number of patients who abandon their treatment regime. There are currently various models applied to ensure treatment adherence.
One of these models includes the involvement of a family member to support the DOT. In this case, (dependent on eligibility criteria), the patient does not have to go to an outpatient facility every day to get their medicines. Instead, the medicines are given to the trained family member or another treatment supporter, from their immediate social circle (for example a neighbour) weekly. From there, SMS reminders are sent daily to ensure pills are taken in time and healthcare workers provide oversight and monitoring. This is a radical and exciting move as many other systems have argued that family members cannot be trusted to fulfil this role, despite the potential cost-saving and efficiency it can provide. Implementation research done by the American University of Armenia suggests that this is not the case and that it can be a very useful method to encourage treatment adherence. It will therefore be very important to follow the success of this route in order to advocate for its use in other areas.
Our TB-REP2 civil society partner, Positive People Armenian Network (PPAN), is active both in HIV and TB work and undertakes a significant amount of operational support for individuals with TB. Besides advocacy and awareness-raising activities to promote people-centred models of TB care, PPAN staff are highly involved in the provision of direct peer support, motivating people undertaking TB treatment to keep positive treatment outcome perspectives, not to give up and stay adherent through treatment. They also actively promote activities aimed at confronting stigma towards people with TB and their loved ones.
Unfortunately, the donor environment for TB funding is shrinking, which affects the scale of direct services provided by civil society. The Republic of Armenia is looking for ways to strengthen the social contracting mechanisms and find effective ways of budget allocations to sustain its services.
TBEC extends our sincere gratitude to our partners and TB stakeholders in Armenia for meeting with our team and providing helpful insights. A particular thank you to TBREP2.0 civil society partner «Դրական մարդկանց հայկական ցանց» ՀԿ/”Positive People Armenian Network” NGO for all their support in organising this visit.
The activity has been made possible with funding provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) through the grant TB Regional EECA Project (TB-REP2.0) on Advancing People-Centered Quality TB Care – From the New Model of Care Towards Improving DR-TB Early Detection and Treatment Outcomes. The author’s (authors’) views expressed in this publication do not necessarily reflect the views of the GF, Principal Recipient and other Partners of the TB-REP2.0 project.