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P 101457Z MAR 08
FM AMEMBASSY YEREVAN
TO RUEHC/SECSTATE WASHDC PRIORITY 7156
INFO RUEHZL/EUROPEAN POLITICAL COLLECTIVE PRIORITY
RUEAUSA/DEPT OF HHS WASHDC PRIORITY

UNCLAS SECTION 01 OF 02 YEREVAN 000203 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
STATE FOR EUR/CARC, EUR/PGI:DTESSLER AND OES/IHB:ALAURITZEN 
 
E.O. 12958: N/A 
TAGS: TBIO WHO AM
SUBJECT: ARMENIA: IMPLEMENTATION OF THE BERLIN DECLARATION 
ON TB 
 
REF: STATE 6989 
 
¶1.  Pursuant to reftel request, post reports the following on 
the status of implementation in Armenia of the Berlin 
Declaration on Tuberculosis. 
 
¶2.  On 27 February Embassy Officers attended a meeting with 
the National Tuberculosis Program Manager Vahan Pogosian and 
his deputy Tatevik Kostanian to discuss Armenia's 
implementation of its World Health Organization (WHO) 
obligations as outlined in the Berlin Statement on 
Tuberculosis.  At the meeting, Pogosian provided Emboffs with 
a historical background of the National TB Program (NTBP) in 
Armenia and its major accomplishments to date.  The current 
NTBP is the second phase of a program created with WHO 
assistance to eradicate Tuberculosis in Armenia over 
2007-2015.  The first phase of this program was successfully 
completed during the 2003-2006 time frame.  As a result, the 
NTBP closely follows the WHO's "Stop TB Strategy" for high 
priority countries in the WHO European Region. 
 
ACCOMPLISHMENTS 
 
¶3.  According to Pogosian, the Armenian NTBP has succeeded in 
implementing several of the steps outlined in paragraph five 
of the Berlin Statement.  These include but are not limited 
to: 1) The establishment of a Country Coordination Mechanism 
made up of representatives of the various stakeholder 
ministries and NGOs and which meets quarterly to discuss TB 
developments in Armenia; 2) The training of primary care 
providers on modern TB treatment strategies; 3) The building 
of a new hospital that specializes in the treatment of 
man-made multidrug-resistant TB (MDR-TB); and 4) The 
establishment of regional TB treatment centers throughout 
Armenia.  In addition, the Armenian NTBP is pursuing joint 
projects with its Georgian counterpart under the leadership 
of Georgia's First Lady. 
 
¶4.  Pogosian regretted to inform Emboffs that there has been 
virtually no private sector or civil society involvement in 
the fight against TB in Armenia.  However, he was pleased to 
report on the successes of a pilot project that his 
organization was pursuing with the French NGO Medecins Sans 
Frontieres (MSF) to treat MDR-TB.  In addition, he stated 
that NTBP-Armenia was receiving support from the German 
government, the Global Fund (to Fight Aids, TB, and Malaria), 
the International Red Cross, the United Methodist Committee 
on Relief (UMCOR), and local NGO "Save the Children from TB". 
 (Embassy comment:  USAID has provided the Government of 
Armenia with over 200,000 USD in technical assistance). 
 
¶5.  Concerning collaboration between Armenia's TB and HIV 
programs, Pogosian noted that he was also head of the 
National HIV Action Plan (NHAP) and that Country Coordination 
Mechanism for TB was also used to address the tandem 
treatment plans for those with TB and HIV. 
 
CHALLENGES 
 
¶6.  Armavir and Syunik Marzes (regions) experienced a 
relatively higher number of registered cases recently, which 
Pogosyan partially attributed to the lower economic status of 
the inhabitants.  A significant number of new MDR-TB cases 
were registered within Armenia's prison population. 
Currently, treatment is not compulsory.  However, those 
infected are provided free treatment and severe cases are 
sent to Yerevan for further treatment.  In addition, free 
diagnostic services are provided to people who have been 
exposed. 
 
¶7.  While the number of new TB cases registered in Armenia 
has not exceeded the 1500 per-year mark for the past couple 
of years, the percentage of cases registered with MDR-TB has 
increased significantly.  According to Pogosian, this was due 
to an increase in human error during the treatment of regular 
TB.  By training primary care providers on new TB treatment 
strategies, Pogosian hoped to decrease the total number of 
registered cases as well as address the human resource 
shortfall in TB treatment.  Pogosian also mentioned that the 
NTBP expected a budget gap of seven million USD for the 
building of a new hospital specially equipped to treat MDR-TB 
and that he would be applying to the G-8 for assistance. 
 
PERSPECTIVES OF THE WHO PROGRAM MANAGER FOR ARMENIA 
 
¶8.  Emboffs met with the WHO Program Manager for Armenia, 
Gayane Ghukasian, who reported that the NTBP had a 72 percent 
successful treatment rate using the Directly Observed 
 
YEREVAN 00000203  002 OF 002 
 
 
Treatment Shortcourse (DOTS) strategy, whereas the WHO 
standard for treatment was 80 percent.  Ghukasian stated that 
despite attempts to integrate DOTS into the general 
healthcare system, the situation remained alarming due to a 
high number of recidivating cases.  She attributed part of 
the problem to public perceptions of TB as a stigma, causing 
many of the infected to hide their diagnosis.  She also 
assessed the level of collaboration between TB and HIV 
programs to be insufficient, and noted that funding from the 
Global Fund Grant (GFG) would run out by the end of 2009. 
 
¶9.  Ghukasian made the following recommendations:  1) The 
NTBP is a comparatively new structure and needs to improve 
its capacity, management, and staffing due to high turnover; 
2) The NTBP needs to address the lack of public awareness 
that TB is a problem in Armenia; 3) The Armenian government 
needs to review Medical School curricula as well as the 
methods of practicing physicians to treat TB; and 4) Armenia 
must develop a sustainable means to fund it TB action plan 
for the future when international sponsors are gone. 
 
¶10.  COMMENT:  Given that the percentage of the federal 
budget Armenia dedicates to health care spending is one of 
the lowest of all CIS countries, post is concerned that the 
government is not taking the spread of TB and MDR-TB 
seriously.  Moreover, new cases of TB are believed to be 
under-reported among the child population due to the high 
number of children in rural areas who are not even registered 
within the health care system and who therefore do not get 
diagnosed until they begin school. 
PENNINGTON