Factors associated with unfavourable treatment outcomes among people with rifampicin-resistant tuberculosis in Armenia, 2014-2017.

Rifampicin-Resistant/Multidrug-Resistant Tuberculosis (RR/MDR-TB) is recognized as a major public health concern globally. In Armenia, the proportion of RR/MDR-TB is increasing among all people affected with TB. We conducted a nationwide cohort study involving analysis of programmatic data to investigate the rates of and factors associated with unfavourable treatment outcomes among patients with RR/MDR-TB registered by the national TB programme from 2014 to 2017 in Armenia. We used Cox regression to identify factors associated with the outcome. Among 451 RR/MDR-TB patients, 80% were men and median age was 46 years. Of them, 53 (11.8%) had Extensively Drug-Resistant Tuberculosis (XDR-TB) and 132 (29.3%) had pre-XDR-TB. Almost half (224, 49.7%) of the patients had unfavourable treatment outcome, which included 26.8% Loss To Follow-Up (LTFU), 13.3% failures and 9.5% deaths. In multivariable analysis, people with pre-XDR-TB [adjusted Hazard Ratio [aHR] 3.13, 95% confidence intervals [CI] 2.16-4.55] and XDR-TB (aHR 4.08, 95% CI 2.45-6.79) had a higher risk of unfavourable outcomes. Patients receiving home-based treatment (71/451, 15.7%) and treatment with new drugs (172/451, 38.1%) had significantly lower risk (aHR 0.45, 95% CI 0.28-0.72 and aHR 0.26, 95% CI 0.18-0.39) of unfavourable treatment outcome.  The proportion of MDR-TB patients reaching favourable treatment outcome in Armenia was substantially lower than the recommended level (75%). The most common treatment outcome was LTFU indicating the need for further assessment of underlying determinants. Home-based treatment looks promising and future studies are required to see if expanding it to all RR/MDR-TB patients is feasible and cost-effective.

A country-wide evaluation of infection control for tuberculosis in health-care facilities in Armenia.

INTRODUCTION: Infection control at health facilities is an important part of TB control programmes. To assess the implementation of tuberculosis infection control (TB IC) measures and barriers hindering their implementation in TB health care facilities (HCFs) in Armenia; to report the feasibility of using the WHO recommended checklist. METHODOLOGY: A cross-sectional survey using WHO TB-IC checklist and direct observations was conducted between January and May 2018. RESULTS: The survey included all 62 TB institutions in Armenia. TB HCFs in Armenia had implemented some recommended TB IC measures: offering IC training to staff (48%), shortening time to diagnosing TB to less than one day (29%) and ensuring good ventilation (60%). N95 respirators were available in all HCFs. However, barriers that hindered implementation of TB IC measures were: lack of training, a different incentive model for primary care doctors versus TB doctors and lack of space and poor conditions of the building. CONCLUSION: The use of the standardized WHO checklist in this first evaluation of TB IC measures in Armenia was found to be useful and feasible in identifying areas of weak IC implementation and barriers to achieving good infection control. Other TB programs may benefit from the use of this model of assessment, based on the WHO checklist.

Performance assessment through pre- and post-training evaluation of continuing medical education courses in prevention and management of cardio-vascular diseases in primary health care facilities of Armenia.

To assess the difference of pre- and post-training performance evaluation of continuing medical education (CME) courses in cardio-vascular diseases (CVD) management among physicians at primary health care facilities of Armenian regions we conducted an evaluation survey. 212 medical records were surveyed on assessment of performance before and after the training courses through a self-employed structured questionnaire. Analysis of survey revealed statistically significant differences (p < 0.05) in a number of variables: threefold increased recording of lipids and body mass index (p = 0.001); moderate increased recording of comorbidities and aspirin prescription (p < 0.012); eightfold increased recording of dyslipidemia management plan, twofold increased recording for CVD management plan and fivefold increased recording for CVD absolute risk (p = 0.000). Missing records of electrocardiography and urine/creatinine analyses decreased statistically significantly (p < 0.05). Statistically significant decrease was observed in prescription of thiazides and angiotensin receptor blockers/angiotensin converting enzyme inhibitors (p < 0.005), while prescription of statins and statins with diet for dyslipidemia management showed increased recording (p < 0.05). Similarly, we observed increased records for counseling of rehabilitation physical activity (p = 0.006). In this survey most differences in pre- and post-evaluation of performance assessment may be explained by improved and interactive training modes, more advanced methods of demonstration of modeling. Current findings may serve a basis for future planning of CME courses for physicians of remote areas facing challenges in upgrading their knowledge, as well as expand the experience of performance assessment along with evaluation of knowledge scores.

Influence of diabetes mellitus type 2 and prolonged estrogen exposure on risk of breast cancer among women in Armenia.

Diabetes mellitus type 2 (DM2) and breast cancer (BrCa) are prevalent in Armenia. We investigated DM2, reproductive factors, and BrCa in a case control study of 302 women. Multiple logistic regression analyses revealed DM2 increased adjusted odds of BrCa by 5.53 (95% CI 1.34-22.81). Any birth was protective (adjusted OR=0.36, 95% CI 0.20-0.66). Each year delay in first pregnancy increased risk (adjusted OR=1.13, 95% CI 1.01-1.27) as did induced abortions (adjusted OR=2.86, 95% CI 1.02-8.04). Odds ratios were adjusted for age and body mass index (BMI), which confounded associations between DM2 and BrCa. We suggest our findings imply the need for further investigation in Armenian and in other populations with similar characteristics.