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The number of hospitalizations was reduced by 76% from 2013 to 2017. The average duration of stay reduced as well from 55+ days to 37 days. However, the proportion of smear negative TB patients remains high among all hospitalized patients (63.8%). CONCLUSIONS Overall, the reform has been successful, however unnecessary hospitalizations persist. Our results indicate there a need to go upstream for a structural and financial reform of the outpatient sector to complete Armenia's TB healthcare reform and improve both patient outcomes and eff