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Dr. Arusyak Melikyan (right) is one of MSF consultants in Vanadzor. Together with Dr. Narine Kherimyan (left), a doctor from the Ministry of Health, she follows DR-TB patients.<br> *** Local Caption *** Treatment options for patients with drug-resistant TB remain far short of what is needed. Treatments are long (up to 2 years), toxic (serious side-effects) and expensive. Furthermore, the cure rate is only 50%.
Bedaquiline, one of two new TB drugs to be developed in 50 years, is as yet only available for compassionate use, i.e., patients for whom most antibiotics are not effective. MSF has been administering a new treatment including bedaquiline to around thirty patients in Armenia since April 2013. Although we can not draw any definitive conclusions (at this point), several patients have shown significant signs of improvement and we have not observed any side effects associated with bedaquiline until now.
But, while compassionate use of this new drug gives cause for optimism to patients who have lost hope, it is not the solution for treating the hundreds of thousands of patients worldwide suffering from DR-TB. New, shorter, less toxic and cheaper treatments including bedaquiline and delamanid, the other new TB drug, need to be developed.
International Activity Report 2019

Armenia

Dr Arusyak Melikyan (right), one of MSF’s consultants in Vanadzor, and Dr Narine Kherimyan, a doctor from the Ministry of Health, examining X-rays of a drug-resistant tuberculosis patient. Armenia, February 2014.
© Andrea Bussotti/MSF
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MSF in Armenia in 2019 MSF has helped to tackle resistant forms of tuberculosis (TB) in Armenia since 2015. In 2019, we handed over our remaining activities to the national health authorities.
Map with all MSF projects in 2019
Map showing location of MSF projects in Armenia 2019.
© MSF

Armenia has one of the highest rates of drug-resistant TB (DR-TB) in the world. In 2005, MSF began working with the national tuberculosis programme to provide treatment for patients with this form of the disease in the capital, Yerevan. Ten years later, Armenia was one of the first countries to use delamanid, a drug that promised to be less toxic and more effective. Between 2015 and 2019, over 1,700 patients were enrolled in our DR-TB programme.

More than 1,500 received conventional treatments, while 107 participated in the endTB observational study, an international initiative aimed at finding shorter, less toxic and more effective treatments for DR-TB. Other patients received bedaquiline, another of the newer drugs, as part of a compassionate use programme, whereby patients are given access to investigational drugs. Such drugs are not approved for mass production but there is sufficient evidence of their potential benefits and limited risks.

With the National Control Centre for Tuberculosis (NTCC), the MSF-supported project in Armenia was able to implement many innovative advances, including systematic testing for chronic active hepatitis among multidrug-resistant TB (MDR-TB) patients, treatment with direct-acting antivirals and all-oral regimens. We handed over activities to the NTCC once the endTB study was complete. 

We first worked in Armenia in 1988 to respond to medical needs following the Spitak earthquake.  Over the next three decades, activities included the provision of medical equipment and support during the Nagorno-Karabakh war (1992–1997), a TB project in Nagorno-KarabakhNagorno-Karabakh is a self-proclaimed republic internationally recognised as belonging to Azerbaijan, but which is home to many ethnic Armenians. (1997-2002) and a project for children experiencing cruel treatment in a special education complex in Yerevan (1997-2004).