Aim: The objectives of the study were measuring knowledge, attitude, and practice scores among general practitioners on antibiotic resistance; exploring associations between antibiotics prescribing practice score among general practitioners and their knowledge and attitude scores after adjusting for other factors; and identifying barriers for rational antibiotics prescription by general practitioners. Methods: A cross-sectional study design was used. A self-administered survey was conducted among general practitioners employed in private and public polyclinics in Yerevan, Armenia. All general practitioners, working in Yerevan polyclinics and fluent in the Armenian language, were eligible for the study. The study was conducted in primary healthcare facilities of Yerevan, Armenia. All polyclinics (n=18) serving 30,000 or more populations were included in the study. All general practitioners available in selected polyclinics at the time of the survey were invited to take part in the survey, to target 20 general practitioners from each polyclinic. Results: Overall, 291 general practitioners participated in the study. Knowledge, attitude, and practice mean percent scores were 58.3%, 67.5%, and 63.0%, respectively. In the adjusted analysis, the practice percent score was significantly associated with the attitude percent score, though the relationship between the practice and knowledge scores was insignificant. The main barriers reported by general practitioners: lack of rapid diagnostic tests, high costs of laboratory tests, high costs of some antibiotics, and lack of guidelines. Conclusion: Identified low knowledge, attitude, and practice mean percent scores suggest a need for improvements in these areas. Availability of rapid and inexpensive diagnostic tests, enforcement of prescriptions could potentially prevent the development of antibiotic resistance. Keywords: drug resistance, general practitioners, polyclinics, prescribing

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Background Liver damage caused by hepatitis C virus (HCV) is common, especially in low- and middle-income countries. Chronic HCV infection is among the leading causes of chronic liver disease, cirrhosis and hepatocellular carcinoma. Data on prevalence and risk factors of HCV infection are important for planning effective interventions to fight the virus. This study investigated the prevalence of HCV, its genotypes and factors associated with chronic HCV infection in Armenia. Methods The study included 3838 individuals 18 years and older selected via stratified two-stage cluster sampling from all regions of Armenia. Anti-HCV antibodies were detected using a third generation immunoassay. Those testing positive were further tested by Polymerase Chain Reaction and genotyping. Shortly after testing, the participants underwent a telephone survey. Logistic regression model was fitted to identify factors associated with chronic HCV infection. Results The participants mean age was 49.5 years, 70.0% were female. The prevalence of HCV antibodies weighted by age and sex was 1.9% (95% CI 1.5, 2.3), and chronic HCV infection - 0.7% (95% CI 0.4, 0.9), with genotype 3 being the most common (41.7%), followed by genotypes 2 (37.5%) and 1 (20.8%). The prevalence of both antibodies and chronic infection were higher among 50-69 years old (3.4% and 1.3%, respectively). In weighted analysis, the risk factors for chronic HCV infection included male sex (95% CI 1.23, 11.59), having tattoos (95% CI 1.10, 7.80), and reporting liver disease (95% CI 1.24, 14.61). Being employed was protective (95% CI 0.14, 0.93). Conclusions This study was the first attempt to measure the prevalence of HCV infection among the general population of Armenia, creating prerequisites for estimating the HCV-related disease burden and developing strategies to cope with it. The identified risk factors demonstrate that there is still room for strengthening safety measures to prevent the transmission of HCV in Armenia. Key messages • The prevalence of HCV antibodies is 1.9% among adult population of Armenia, increasing with age. Over one-third of seropositive cases have chronic infection caused by HCV genotypes 3, 2 or 1. • Having tattoos is associated with higher risk of being infected with HCV, demonstrating the need for strengthening safety measures during similar procedures to prevent viral transmission.

Background Data on parameters of actual exposure to SARS-CoV-2 is limited, and specific population groups might be at a higher risk of infection. In line with the growing need for large-scale investigations to determine the presence of antibodies against SARS-CoV-2 among different population groups, we conducted a nationwide assessment in Armenia. Methods We performed a cross-sectional seroepidemiological study among the adult population in Armenia, in May-September 2021. A multi-stage cluster random sampling was performed to recruit the participants across the capital city and regions. The study had two main components: blood sampling, which took place in primary care facilities and a phone survey on socio-demographic characteristics, comorbidities, and previous history of COVID-19. Results The number of participants included in both blood sampling and phone survey was 3483. The nationwide prevalence of SARS-CoV 2 antibodies weighted by age and gender was 66.4% with significantly higher prevalence in urban compared to rural areas (67.3% vs 59.3%, p < 0.001). Only 22.7% (n = 772) of the total sample reported a previous history of PCR confirmed COVID-19, among whom antibodies were detected in 94.2% (n = 727). In the final adjusted model, the seropositivity was associated with being female (OR = 1.60, 95% CI: 1.32; 1.92), employed (OR = 1.41, 95% CI: 1.17; 1.69), and having previous PCR confirmed COVID-19 (OR = 10.6, 95% CI: 7.39; 15.21). Conclusions Over 66% of the population were seropositive for antibodies against SARS-CoV 2; and over ⅕ of the sample reported a previous PCR diagnosis. Factors associated with increased odds of seropositivity included gender, employment status, and place of residence. Targeted interventions are recommended to minimize the risk of infection among those groups, including vaccination and infection prevention and control measures. Key messages • The prevalence of SARS-CoV 2 antibodies is about three times higher than the rate of infection based on PCR confirmed prevalence of COVID-19. • Women, people living in urban areas, and those employed are at a higher risk for exposure to SARS-CoV 2.

Background Antibiotic resistance is an important public health issue. This study sought to measure general practitioners' (GPs) knowledge, attitude, and practice on antibiotic resistance; explore the adjusted associations between their antibiotics prescribing practice score and knowledge and attitude scores, and identify barriers for rational prescription of antibiotics by GPs. Methods A cross-sectional self-administered survey was conducted among GPs. Multivariable linear regression was applied to analyze the data. Results Overall, 291 GPs participated in the study. Knowledge, attitude, and practice mean percent scores were 58.3%, 67.5%, and 63.0%, respectively. In the adjusted analysis, the practice percent score was significantly associated with the attitude percent score (β = 0.58; 95% CI: 0.41, 0.75; p < 0.001), though the relation between the practice and knowledge scores was insignificant. The main barriers reported by GPs: lack of rapid diagnostic tests, high costs of laboratory tests, high costs of some antibiotics, and lack of guidelines. Conclusions Identified low knowledge, attitude, and practice mean percent scores suggest a need for improvements in these areas. Availability of rapid and inexpensive diagnostic tests, enforcement of prescriptions could potentially prevent the development of antibiotic resistance. Key messages Availability of rapid and inexpensive diagnostic tests, enforcement of prescriptions, and regulation of antibiotics’ prices could help to improve antibiotics prescribing practices of GPs. Low knowledge, attitude and practice levels regarding antibiotic resistance among GPs in polyclinics suggests a need for improvement in these areas.