“Thanks to the Assessment, we were able to identify key populations in Armenia that are particularly vulnerable to tuberculosis. On this basis, advocacy activities will be carried out to adapt, improve and strengthen the provision of anti-tuberculosis care to representatives of key groups who do not receive the necessary medical care, - said Ayk Davtyan, TB RPC.“This is the first time such an assessment has been carried out in Armenia, and we have a lot of work to do together with country partners to develop and improve the TB care system in the country, so that it becomes maximally people-centered. Our organization is grateful to all the country partners for their huge contribution to this work. I would especially like to mention the National Center for Pulmonology and the Coordination Group of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Ministry of Health, and also express my deep gratitude to our international partners, in particular to the PAS Center, without which this work would not have been possible”.
The event was organized by the Center for Research and Prevention of Tuberculosis (TB RPC) in partnership with the Center for Health Policy and Studies (PAS Center), within the framework of the TB REP 2.0 Global Fund regional project.
“Congratulations to the partners from Armenia on the implementation of the CRG Assessment. At the end of last year, the TB REP 2.0 team already presented a regional overview “Breaking the Silence: Barriers to Human Rights, Gender, Stigma and Discrimination in TB Services in Georgia, Kazakhstan, Kyrgyzstan, Tajikistan and Ukraine”. And we are very pleased to carry out such a study in Armenia as well. The results of this CRG Assessment in Armenia will be a valuable resource for further provision of TB care, based on the needs of people from the analyzed key groups, ”said Cristina Celan, PAS Center.
Within the framework of the working meeting, with the participation of stakeholders’ representatives, the results of the CRG Assessment were presented and discussed followed by participants' feedback and comments. Based on the results of the study, the main key groups were identified, namely: homeless people, migrants, people living with HIV.
Thus, Lilit Gevorgyan, a phthisiatrician from the National Center for Pulmonology (National Tuberculosis Control Program) presented the results of the study on the group of homeless people. Among the key recommendations, she mentioned the need to provide the homeless with structured health psychosocial support, individual or group counseling throughout the treatment so that they understand the course of the disease and the importance of systemic treatment. It is also recommended to organize a shelter for the homeless - a place where they can stay throughout the entire period of outpatient treatment without interruption, and to provide them with increased social protection to prevent interruption of treatment due to domestic problems. This shelter can also solve the legal side of the issue. This way, the homeless will be able to obtain a residence address and use it to register at polyclinics, which is necessary for prescribing the TB treatment. Due to the lack of a place of residence, homeless people often face insurmountable legal barriers, which very often interrupt outpatient treatment.
Dzovinar Melkomyan, Public Health Specialist, research fellow, presented the results of the study on the key group of migrants. For example, she noted that an important next step in working with this group would be a TB awareness, screening and support campaign. Also, according to her, it is necessary to educate opinion leaders in the migrant community who will help to raise awareness of existing social, legal and medical services for migrant workers in Armenia and the host countries. Also, an extremely important aspect is the development of cooperation between Armenia and the countries where the largest number of migrants work. It is essential to improve strong and sustainable tools for coordinating and monitoring TB services for migrant workers in the countries. It is especially important to build a service system for migrants in the Russian Federation, since 90% of migrants from Armenia migrate to Russia. People with TB who travel to Russia and interrupt the treatment, very often want to continue receiving the medicine, but they cannot. It is impossible to send the medicines, because the import of medicines requires a declaration and the question arises about the diagnosis of patients with subsequent deportation. Some medicines are not registered and their import to Russia is prohibited.
Serine Saakyan, Public Health Specialist, research fellow, presented the results of the study on gender and stigma. In the context of stigmatization, there is an acute issue of advocating for a change in the order on "Deportation for TB status" in Russia and providing treatment in the host country. The need to maintain confidentiality for patients and, at the same time, exchange data between the HIV treatment center and TB clinics was emphasized. For example, at the moment, Russia deports tuberculosis patients upon detection, providing only first aid assistance, which leads to the fact that people hide their diagnosis so as not to lose their jobs.
Naira Sergeeva, representative of the Ministry of Health, the Global Fund Steering Group, spoke about the results of the study on the key group of people living with HIV. She outlined the legal barriers for the general population in the context of TB. The most difficult situation in this context is faced by migrants and, given the legal barriers described in the results, one of the possible options for protecting their rights is the Intercountry Agreements. Under the terms of such agreements, all labor migrants diagnosed with HIV and TB in Russia would receive the opportunity to be put on treatment in the Russian Federation, regardless of their legal status. And the Republic of Armenia will be responsible for reimbursing all the costs associated with the treatment of these patients. In addition, if due to the restrictions of the law, the deportation procedure cannot be suspended, then a procedure should be developed to officially notify the Armenian officials about the arrival of a TB patient.
As a result of the discussion, the final results of the assessment and a number of main recommendations were agreed upon, on the basis of which a plan for further actions to advocate for improving TB care for representatives of key groups in the country was drawn up.
“We will continue the research work in the field of tuberculosis, as well as work on the implementation of the necessary measures to further improve the anti-tuberculosis system in the country. On this path, the support and partnership of country and international partners is very important for us, ”said Ayk Davtyan, TB RPC.