rGLC Europe

DATA REQUEST FOR

COUNTRY SUPPORT MISSION REPORT

Country: Armenia

Dates of mission: December12-16, 2022

Consultant(s): Dr Nino Lomtadze, international TB consultant

Dr Maria Dolynska, international TB consultant
Dr Alexandra Solovyeva, international TB consultant

1
Contents

Epidemiology........................................................................................................................................4
Table 1. TB case notifications, 2016 – 2022(6m)................................................................................4
Table 1a. Monthly notification of TB and RR-TB, 2019-20226m (for assessment of COVID19 impact)
...........................................................................................................................................................4
Table 2. TB case notifications by category, 2017-2022 (6m)..............................................................5
TB diagnosis..........................................................................................................................................5
Table 3. FLD and SLD resistance profile among new TB cases, 2018–2022 (6m)................................5
Table 4. FLD and SLD resistance profile among previously treated TB cases, 2018–2022 (6m).........5
Table 5. Number of microscopy, culture and DST investigations, 2018-2022 6m..............................6
Table 6. Structure of TB diagnostic / laboratory network and methods used....................................7
Table 7. Number of Xpert MTB/RIF instruments and investigations performed, 2014-2020.............7
Table 8. Xpert MTB/RIF testing results, 2016-2022 6m......................................................................7
Table 9. Availability of DST to new and repurposed TB drugs, as of January 2021 (Yes/No)..............7
TB treatment.........................................................................................................................................8
Table 10. TB treatment outcomes, new and relapse cases notified, 2016-2021 cohorts...................8
Table 11. TB treatment outcomes, previously treated cases notified (other than relapse), 2016-
2021 cohorts......................................................................................................................................8
Table 12. Number of RR/MDR-TB patients enrolled in treatment, 2016-2022 6m.............................8
Table 13. TB treatment outcomes, RR/MDR-TB cases enrolled to shorter treatment regimen, 2016-
2020 cohorts......................................................................................................................................8
Table 14. TB treatment outcomes, RR/MDR-TB cases notified, on longer treatment regimen, 2016-
2022 cohorts......................................................................................................................................9
Table 15. TB treatment outcomes, RR/XDR-TB cases notified, 2017-2022 cohorts*..........................9
Table 16. Number of TB inpatient facilities, number and profile of TB hospital beds, by sector and
level of care........................................................................................................................................9
Table 17. Main activity indicators for institutions providing inpatient treatment of active TB cases,
country-wide, 2014-2020.................................................................................................................10
3. TB systematic screening.................................................................................................................10
Table 18. Number of TB suspects tested for active TB disease, 2017-2022 (6m).............................10
Table 19. Number of TB contacts tested for active TB disease, 2017-2022 (6m).............................10
Table 20. Number of other key population and vulnerable groups tested for active TB disease,
2017-2022 (6m)................................................................................................................................11

2
 Table 21. Number of PLHIV screened for active TB disease, 2016-2021..........................................11
TB infection (TBI) screening and preventive treatment (TPT)......................................................12
Table 22. TB contacts coverage with screening of TB infection/ TBI and TPT, 2017-2022 (6m).......12
Table 23. PLHIV coverage with screening of TB infection/ TBI (if applicable) and TPT, 2017-2022
(6m)..................................................................................................................................................12
Table 24. Coverage with screening on TB infection/ TBI (if applicable) and TPT among other key
population and vulnerable groups, 2017-2022 (6m)........................................................................13

3
Epidemiology
Table 1. TB case notifications, 2016 – 2022(6m)
2016 2017 2018 2019 2020 2021 2022 (6m)

New cases
Previously treated
cases
All TB cases
TB mortality
Population used for
rate calculationa
New cases per
100 000
Previously treated
cases per 100 000
New and relapse
cases per 100 000
All TB cases per
100 000
TB mortality per
100 000
Incident (new and
relapse) cases in
children (0–14
years)
Notified RR-TB
cases
Enrolled RR-TB
cases
TB/HIV cases out
of all TB cases
Source(s):
Table 1a. Monthly notification of TB and RR-TB, 2019-20226m (for assessment of
COVID19 impact)
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Monthly TB notification

2019

2020

2021

2022 6m

Monthly RR-TB notification

2019

2020

2021

4
 2022 6m

Table 2. TB case notifications by category, 2017-2022 (6m)

2017 2018 2019 2020 2021 2022 (6m)
New cases total:
New pulmonary laboratory confirmed
New pulmonary clinically diagnosed
New extrapulmonary laboratory
confirmed
New extrapulmonary clinically
diagnosed
Previously treated cases total:
Relapses pulmonary laboratory
confirmed
Relapses pulmonary clinically
diagnosed
Relapse extrapulmonary laboratory
confirmed
Relapse extrapulmonary clinically
diagnosed
Other previously treated pulmonary
laboratory confirmed
Other previously treated clinically
diagnosed
Other previously treated
extrapulmonary laboratory confirmed
Other previously treated
extrapulmonary clinically diagnosed
All TB cases
Source(s):

TB diagnosis
Table 3. FLD and SLD resistance profile among new TB cases, 2018–2022 (6m)
2018 2019 2020 2021 2022 (6m)
Line N N N N N
1 Number of new TB cases notified
2 Number of pulmonary cases out of line
1
3 Number of laboratory confirmed cases
out of line 2
4 Number of cases with DST result to
rifampicin (Rif) out of line 3
5 Number of Rif-resistant TB (RR-TB)
cases out of line 4
6 Number of cases with DST results to
fluoroquinolones (fq) out of line 5
7 Number of cases sensitive to fq out of
line 6
8 Number of cases resistant to fq out of
line 6
9 Number of cases with DST results both
to linezolid (Lzd) and bedaquiline (Bdq)
out of line 8
10 Number of cases sensitive to both Lzd
and Bdq out of line 9
11 Number of cases resistant to both Lzd
and Bdq out of line 9
12 Number of cases resistant to Bdq and
sensitive to Lzd out of line 9
Source(s):

5
Table 4. FLD and SLD resistance profile among previously treated TB cases,
2018–2022 (6m)
2018 2019 2020 2021 2022 (6m)
Line N N N N N
1 Number of previously treated TB cases
notified
2 Number of pulmonary cases out of line 1
3 Number of laboratory confirmed cases
out of line 2
4 Number of cases with DST result to
rifampicin (Rif) out of line 3
5 Number of RIF-resistant TB (RR-TB)
cases out of line 4
6 Number of cases with DST results to
fluoroquinolones (fq) out of line 5
7 Number of cases sensitive to fq out of
line 6
8 Number of cases resistant to fq out of line
6
9 Number of cases with DST results both to
linezolid (Lzd) and bedaquiline (Bdq) out
of line 8
10 Number of cases sensitive to both Lzd
and Bdq out of line 9
11 Number of cases resistant to both Lzd
and Bdq out of line 9
12 Number of cases resistant to Bdq and
sensitive to Lzd out of line 9
Source(s):
Table 5. Number of microscopy, culture and DST investigations, 2018-2022 6m
2018 2019 2020 2021 2022 6m

Direct smear microscopy (DSM)

Culture on solid media

DST to FLDs on solid media

DST to SLDs on solid media

Culture in liquid media (automated MGIT)

DST to FLDs in liquid media (automated

MGIT)
DST to SLDs in liquid media (automated
MGIT)
LPA MTBDR-Plus

LPA MTBDR-sl

Xpert XDR

6
Table 6. Structure of TB diagnostic / laboratory network and methods used
Number of facilities performing:
Solid media investigations Liquid media investigations Line Probe Assays
Number of
(e.g. LJ) (automated MGIT) (LPA)
TB
Region / sector Xpert
diagnostic DSM GenoTyp GenoTyp
facilities * MTB/RIF DST to DST to DST to DST to e e
Culture Culture
FLDs SLDs SLDs FLDs MTBDR- MTBDR-
Plus sl
Region 1 …

Region 2 …

Region X …

Civilian sector total

Penitentiary sector

Country total
Source(s):
* Note: laboratories, as well as basic management units using Xpert only, should be included.

Table 7. Number of Xpert MTB/RIF instruments and investigations performed,

2014-2020
Number of Xpert Number of Xpert MTB/RIF tests performed:
Region / sector MTB/RIF
instruments 2016 2017 2018 2019 2020 2021 2022

Region 1 …

Region 2 …

Region X …

Civilian sector total

Penitentiary sector

Country total
Source(s):
Table 8. Xpert MTB/RIF testing results, 2016-2022 6m
Total Invalid test results Valid test results
number of MTB(+)
Total
Year Xpert “Test “Test “Test No Total valid MTB(+)/ MTB(+)/ MTB+/RIF
invalid MTB(-) MTB(+)
MTB/RIF invalid” error” Result” tests RIF RIF- Inde-
tests total
tests Sensitive Resistant terminate
2018
2019
2020
2021
2022 6m

Table 9. Availability of DST to new and repurposed TB drugs, as of January 2021

(Yes/No)
DST NRL

Bdq

7
 Dlm
Cfz
Lzd

TB treatment
Table 10. TB treatment outcomes, new and relapse cases notified, 2016-2021
cohorts
2016 2017 2018 2019 2020 2021*

  N % N % N % N % N % N %
New and relapse cohort size
Treatment success
Treatment failed
Died
Lost to follow up
Still on treatment
Transfer to DR-TB
Diagnosis is cancelled
Source(s):
*Include number of patients enrolled
Table 11. TB treatment outcomes, previously treated cases notified (other than
relapse), 2016-2021 cohorts
  2016 2017 2018 2019 2020 2021*
N % N % N % N % N % N %
Retreatment cohort size
Treatment success
Treatment failed
Died
Lost to follow up
Still on treatment
Transfer to DR-TB
Diagnosis is cancelled
Source(s):
*Include number of patients enrolled

Table 12. Number of RR/MDR-TB patients enrolled in treatment, 2016-2022 6m

2016 2017 2018 2019 2020 2021 2022 6m

Total number of RR/MDR-TB patients

enrolled in treatment (XDR included)
 out of which, in penitentiary sector

 out of which, children (0-14 years)

 out of which, on shorter treatment

regimens (STRs)
Source(s):

8
Table 13. TB treatment outcomes, RR/MDR-TB cases enrolled to shorter
treatment regimen, 2016-2020 cohorts
2019 2020 2021 2022
 
N % N % N % N %
RR/MDR-TB cohort size (on
shorter regimens)
Treatment success
Treatment failed
Died
Lost to follow up
Still on treatment
Source(s):

Table 14. TB treatment outcomes, RR/MDR-TB cases notified, on longer

treatment regimen, 2016-2022 cohorts
2016 2017 2018 2019 2020 2021 2022 6m
 
N % % % N % N % N % N % N %
RR/MDR-
TB cohort
size (XDR
excluded)
Treatment
success
Treatment
failed
Died
Lost to
follow up
Still on
treatment
Source(s):

Table 15. TB treatment outcomes, RR/XDR-TB cases notified, 2017-2022 cohorts*

2017 2018 2019 2020 2021 2022 6m
 
N % N % N % N % N % N %
XDR-TB cohort
size
Treatment
success
Treatment
failed
Died
Lost to follow
up
Still on
treatment

Source(s):
*Fill-in as per old definition of XDR-TB

9
Table 16. Number of TB inpatient facilities, number and profile of TB hospital
beds, by sector and level of care
Breakdown by level of care
Breakdown by sector
Country (civilian sector)
Type of institutions and beds
total Civilian Penitentiar Central Regional District
sector y sector level level level
Number of facilities providing hospital
treatment of patients with active TB
Total number of beds for treatment of
active TB
 out of which, for DR-TB patients
 out of which, for children
 out of which, for extrapulmonary TB
 out of which, for surgery
Number of facilities providing palliative
care for TB patients
Number of beds for palliative care
Number of facilities providing involuntary
isolation of TB patients
Number of beds for involuntary isolation
Source(s):

Table 17. Main activity indicators for institutions providing inpatient treatment of
active TB cases, country-wide, 2014-2020
2014 2015 2016 2017 2018 2019 2020

Total number of beds for treatment of active TB

Total number of hospitalizations (discharges)

Total number of patient-days (‘bed-days’)

Average length of stay, days

Bed occupancy rate, %

Number of surgical interventions, all types

Surgical activity, %
Source(s):
* Note: Where available, include data for DR-TB cases (expand the table or describe in text). For the current year, include
data for 6 months if available from the NTP.

TB systematic screening.
Table 18. Number of TB suspects tested for active TB disease, 2017-2022 (6m)
Region/sector 2017 2018 2019 2020 2021 2022 (6m)

Region 1  
Region 2
Region 3
…

10
Civilian sector total
Penitentiary sector
Country total

11
Table 19. Number of TB contacts tested for active TB disease, 2017-2022 (6m)
Region/sector 2017 2018 2019 2020 2021 2022 (6m)

Region 1
Region 2
Region 3
…
Civilian sector total
Penitentiary sector
Country total
Source(s):

Table 20. Number of other key population and vulnerable groups tested for active
TB disease, 2017-2022 (6m)
Region/sector 2017 2018 2019 2020 2021 2022 (6m)

Civilian sector total

Penitentiary sector
Country total
Source(s):

Table 21. Number of PLHIV screened for active TB disease, 2017-2022 (6m)
Region / sector 2017 2018 2019 2020 2021 2022 (6m)
Registered PLHIV
PLHIV screened for active TB
disease
Civilian sector total
Penitentiary sector
Country total
Source(s):

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TB infection (TBI) screening and preventive treatment (TPT)
Table 22. TB contacts coverage with screening of TB infection/ TBI and TPT,
2017-2022 (6m)
    Number of TB contacts
Year Age group Screened Eligible TPT TPT TPT TPT Active Death Still on
on TBI for TPT started completed stopped stopped TB TPT
(whole due to due to detected
course) AE other during
reason TPT

2017 Children <5                  

 
Children >5,                  
 
adolescence

Adults                  
2018 Children <5                  
 
Children >5,                  
 
adolescence

Adults                  
2019 Children <5                  
 
Children >5,                  
 
adolescence

Adults                  
2020 Children <5                  
 
Children >5,                  
 
adolescence

Adults                  
2021 Children <5                  
 
Children >5,                  
 
adolescence

Adults                  
2022 Children <5                  
(6m)
Children >5,                  
 
adolescence
 
Adults                  

Table 23. PLHIV coverage with screening of TB infection/ TBI (if applicable) and
TPT, 2017-2022 (6m)
Indicators 2017 2017 2018 2019 2020 2022 (6m)
Number of PLHIV
screened on TBI

Eligible for TPT

TPT started  

TPT completed (whole

course)  
TPT stopped due to AE  

13
 TPT stopped due to
other reason
Active TB detected
during TPT
Death
Still on TPT

Table 24. Coverage with screening on TB infection/ TBI (if applicable) and TPT
among other key population and vulnerable groups, 2017-2022 (6m)
Indicators 2017 2017 2018 2019 2020 2022 (6m)
Number of persons
screened on TBI

Eligible for TPT

TPT started  

TPT completed (whole

course)  
TPT stopped due to AE  
TPT stopped due to
other reason
Active TB detected
during TPT
Death
PTP continued

14