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Madybaeva D, Duishekeeva A, Meteliuk A, Kulzhabaeva A, Kadyrov A, Shumskaia N, Kumar AMV. "Together against Tuberculosis": Cascade of Care of Patients Referred by the Private Health Care Providers in the Kyrgyz Republic. Trop Med Infect Dis 2023; 8:316. [PMID: 37368734 PMCID: PMC10304244 DOI: 10.3390/tropicalmed8060316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Until 2021, in the Kyrgyz Republic, tuberculosis (TB) was diagnosed and treated only in the public sector. With funding support of the STOP-TB partnership, the private providers in four regions of the country and Bishkek city were mapped, trained and incentivized to screen for and identify presumptive TB patients and refer them to the public facilities for diagnosis and treatment. In this study, we describe the cascade of care of such patients. This was a cohort study involving secondary analysis of routine data. Of 79,352 patients screened during February 2021-March 2022, 2511 (3%) had presumptive TB, of whom 903 (36%) were not tested for TB [pre-diagnostic loss to follow-up]. A total of 323 (13%) patients were diagnosed with TB, of whom, 42 (13%) were not started on treatment [pre-treatment loss to follow-up]. Among 257 patients eligible for outcome assessment, 197 (77%) had treatment success, 29 (11%) were lost-to-follow-up, 13 (5%) died, 4 (2%) had treatment failure and 14 (5%) were not evaluated. While this donor-funded, pioneering initiative was successful in engaging the private sector, we recommend that the national TB programme scales up the initiative nationally with dedicated budgets, activities and plans to monitor progress. Qualitative research is urgently needed to understand the reasons for the gaps in the care cascade.
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Affiliation(s)
- Dinara Madybaeva
- Public Foundation “AFEW KG”, 14 JalArtis, 103, Bishkek 720047, Kyrgyzstan;
| | - Aiymgul Duishekeeva
- Public Foundation “KNCV KG”, 121 Dzhantoshev St., Bishkek 720020, Kyrgyzstan; (A.D.); (A.K.)
- Department of Phthisiology, Kyrgyz State Medical Academy, 92 Akhunbaev St., Bishkek 720020, Kyrgyzstan
| | - Anna Meteliuk
- International Charitable Foundation Alliance for Public Health, 03150 Kyiv, Ukraine;
| | - Aizat Kulzhabaeva
- Public Foundation “KNCV KG”, 121 Dzhantoshev St., Bishkek 720020, Kyrgyzstan; (A.D.); (A.K.)
- Department of Public Health, Kyrgyz State Medical Academy, 92 Akhunbaev St., Bishkek 720020, Kyrgyzstan
| | - Abdullaat Kadyrov
- National Center for Phthisiology of MoH Kyrgyzstan, Ahunbaev St., 90a, Bishkek 720064, Kyrgyzstan;
| | - Natalia Shumskaia
- Public Foundation “AFEW KG”, 14 JalArtis, 103, Bishkek 720047, Kyrgyzstan;
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, 2 Rue Jean Lantier, 75001 Paris, France;
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Department of Community Medicine, Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Karnataka, Mangalore 575018, India
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Smith LR, Shumskaia N, Kurmanalieva A, Patterson TL, Werb D, Blyum A, Algarin AB, Yeager S, Cepeda J. Cohort profile: the Kyrgyzstan InterSectional Stigma (KISS) injection drug use cohort study. Harm Reduct J 2022; 19:53. [PMID: 35614508 PMCID: PMC9131652 DOI: 10.1186/s12954-022-00633-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/12/2022] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND In Kyrgyzstan and other Eastern European and Central Asian countries, injection drug use and HIV-related intersectional stigma undermines HIV prevention efforts, fueling a rapidly expanding HIV epidemic. The Kyrgyzstan InterSectional Stigma (KISS) Injection Drug Use Cohort is the first study designed to assess the impact of drug use, methadone maintenance treatment (MMT) and HIV stigma experiences among people who inject drugs (PWID) on HIV prevention service utilization. METHODS Adult PWID were recruited from Bishkek city and the surrounding rural Chuy Oblast region in northern Kyrgyzstan via modified time location sampling and snowball sampling. All participants completed a baseline rapid HIV test and interviewer-administered survey. A subsample of participants were prospectively followed for three months and surveyed to establish retention rates for future work in the region. Internal reliability of three parallel stigma measures (drug use, MMT, HIV) was evaluated. Descriptive statistics characterize baseline experiences across these three stigma types and HIV prevention service utilization, and assess differences in these experiences by urbanicity. RESULTS The KISS cohort (N = 279, 50.5% Bishkek, 49.5% Chuy Oblast) was mostly male (75.3%), ethnically Russian (53.8%), median age was 40 years old (IQR 35-46). Of the 204 eligible participants, 84.9% were surveyed at month 3. At baseline, 23.6% had a seropositive rapid HIV test. HIV prevention service utilization did not differ by urbanicity. Overall, we found 65.9% ever utilized syringe service programs in the past 6 months, 8.2% were utilizing MMT, and 60.8% met HIV testing guidelines. No participants reported PrEP use, but 18.5% had heard of PrEP. On average participants reported moderate levels of drug use (mean [M] = 3.25; α = 0.80), MMT (M = 3.24; α = 0.80), and HIV stigma (M = 2.94; α = 0.80). Anticipated drug use stigma from healthcare workers and internalized drug use stigma were significantly higher among PWID from Bishkek (p < 0.05), while internalized HIV stigma among PWID living with HIV was significantly greater among PWID from Chuy Oblast (p = 0.03). CONCLUSION The KISS cohort documents moderate levels of HIV-related intersectional stigma and suboptimal engagement in HIV prevention services among PWID in Kyrgyzstan. Future work will aim identify priority stigma reduction intervention targets to optimize HIV prevention efforts in the region.
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Affiliation(s)
- Laramie R Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA.
| | - Natalia Shumskaia
- AIDS Foundation-East West in the Kyrgyz Republic, Bishkek, Kyrgyzstan
| | | | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Dan Werb
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
- Centre On Drug Policy Evaluation, St. Michael's Hospital, Toronto, Canada
| | - Anna Blyum
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
| | - Angel B Algarin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
| | - Samantha Yeager
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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