2020
Глобальный мониторинг эпидемии СПИДа 2019 Казахстан

I. Общий - по ускорению мер в ответ на ВИЧ

II. Каскад тестирования и лечения ВИЧ - Обеспечить доступ к лечению для 30 миллионов людей с ВИЧ путем достижения целей «90–90–90» к 2020 году

III. Профилактика передачи ВИЧ от матери ребенку - Искоренить новые случаи инфицирования ВИЧ среди детей к 2020 году с обеспечением доступа для 1,6 миллионов детей к лечению от ВИЧ к 2018 году

IV. Профилактика ВИЧ; Ключевые группы населения - Обеспечить доступ к комбинированной профилактике, включая доконтактную профилактику, добровольное медицинское мужское обрезание, снижение вреда и пропаганду использования презервативов, для, как минимум, 90% людей, особенно молодых женщин и девочек-подростков в странах с высоким уровнем распространенности и ключевых групп населения — геев и других мужчин, имеющих половые связи с мужчинами, трансгендеров, работников секс-бизнеса и их клиентов, лиц, употребляющих инъекционные наркотики и заключенных

V. Пол; Стигма и дискриминация - Устранить гендерное неравенство и искоренить все формы насилия и дискриминации в отношении женщин и девочек, лиц, инфицированных ВИЧ, и ключевых групп населения к 2020 году

VI. Знание ВИЧ и доступ к услугам в области сексуального репродуктивного здоровья - Обеспечить 90% молодежи знаниями, умениями и навыками для защиты от ВИЧ и доступом к услугам в сфере полового и репродуктивного здоровья к 2020 году, чтобы снизить число новых ВИЧ-инфекций среди девочек- подростков и молодых женщин до уровня менее 100 000 в год

VII. Социальная защита - Обеспечить социальную защиту с учетом конкретных потребностей в связи с ВИЧ для 75% людей находящихся в группе риска или инфицированных ВИЧ, к 2020 году.

VIII. Услуги, предоставляемые силами сообществ - Довести к 2020 году объем услуг, предоставляемых силами сообществ, до уровня не менее 30 % от общих объемов услуг

IX. Расходы на ВИЧ - Обеспечить увеличение инвестиций в сфере противодействия ВИЧ до 26 млрд. долл. США к 2020 году, с выделением четверти (25 %) средств на комбинированную профилактику ВИЧ-инфекции, и 6 % на регулирование социальных факторов, имеющих решающее значение как для распространения, так и для эффективного противодействия эпидемии

X. Расширение прав и доступ к правосудию - Обеспечить людей, живущих с ВИЧ, находящихся в группе риска или пострадавших от ВИЧ, возможностями по просвещению в сфере имеющихся у них прав и доступом к правосудию и юридическим услугам для профилактики и борьбы с нарушениями прав человека

XI. Oтход от практики изолированного решения вопросов противодействия СПИДу - Обеспечить отход от практики изолированного решения вопросов противодействия СПИДу на основе интеграции в системы предоставления услуг с учетом конкретных нужд и потребностей людей и обеспечения всеобщего охвата услугами здравоохранения, включая лечение туберкулеза, рака шейки матки, вирусных гепатитов В и С

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2020
БЫСТРАЯ ОЦЕНКА ПРОБЛЕМ И ПОТРЕБНОСТЕЙ ЖЕНЩИН, ЖИВУЩИХ С ВИЧ И ЗАТРОНУТЫХ ВИЧ, ПРЕДСТАВИТЕЛЬНИЦ КЛЮЧЕВЫХ ГРУПП НАСЕЛЕНИЯ В ПЕРИОД ПАНДЕМИИ COVID-19 В КАЗАХСТАНЕ

Общественными фондами «Реванш» и «Фонд женщин, живущих с ВИЧ» при поддержке UNFPA было инициировано социологическое исследование в виде быстрой оценки с целью выявить ключевые проблемы и потребности отдельных групп женщин в период пандемии COVID-19, а также изучить ситуацию с сексуальным и репродуктивным здоровьем. Объектом исследования стали женщины, обращающиеся во время пандемии за помощью в кризисные центры и общественные фонды, в частности: женщины, живущие с ВИЧ; женщины, затронутые ВИЧ; представительницы ключевых групп населения, а также женщины, находящихся в сложной жизненной ситуации. В данном исследовании были выделены 4 ключевые группы лиц, которые по определению ЮНЭЙДС особенно уязвимы к ВИЧ и зачастую не имеют адекватного доступа к услугам: люди, употребляющие инъекционные наркотики (ЛУИН), трансгендерные женщины, секс-работницы, а также заключенные (в том числе бывшие заключенные) и лица, содержащиеся под стражей.

По сообщениям многих экспертов в связи с изоляцией людей, вызванной с пандемией COVID-19, во всем мире помимо резкого снижения социально-экономических условий жизни населения вырос уровень бытового насилия в отношении женщин. Директор-исполнитель Структуры «ООН-женщины» Фумзиле Мламбо-Нгкуки даже считает, что речь идет о своего рода «теневой пандемии». Эта проблема стала характерной и для Казахстана. Так, по сообщению начальника управления ювенальной полиции и защиты женщин от насилия комитета административной полиции МВД РК А.Оспанова, в стране за время пандемии количество семейно-бытовых преступлений выросло на 21%. С начала карантина к административной ответственности за противоправные деяния в сфере семейно-бытовых отношений были привлечены 8 тысяч человек2.

Также по данным МВД, в 2020 году в кризисные центры были направлены более 500 жертв бытового насилия. В на данный момент Казахстане функционирует 41 кризисный центр, в 29 из них есть приюты, где оказывается помощь пострадавшим лицам, а в некоторых регионах и самим правонарушителям.

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2019
UNICEF / KSCDID - Almaty
Training Manual: Psychosocial Supervision for Children and Adolescents Living with HIV or Other Chronic Disease

Kazakhstan is part of the youngest epidemic of HIV. The HIV incidence among the general population are 1.82 per 1000, among 15-19 age group - 0.92 per 1000. In 2018, 532 children (under 18 years of age) were registered as having HIV infection. The breakdown of adolescents is unevenly distributed with half living in South Kazakhstan; one fifth in Almaty and Almaty Region, and the rest across the other regions. The experience of working with children and adolescents among professionals differs greatly. The main focus has been medical provision with counseling provided for caregivers and concentrating on HIV treatment. The psychosocial support needs have, until now, been neglected.

For quality psychosocial support, professionals working with children with HIV need a thorough understanding on child-centred, child-rights approaches and how to implement them into their practice. Professionals working with HIV-positive children should be able to locate possible barriers and challenges and find solutions to address these and ensure all children have optimum physical and emotional care provided for them.

Psychosocial support needs to be focused on, and offered to the whole family. It is a way to nurture acceptance and positive parenting in care-givers and support the young person to develop the skills and resilience to lead a full and healthy life.

Children and young people living with HIV are not unique in their need for psychosocial support in managing a chronic health condition. This Training Manual is universal and applicable in different conditions such as hepatitis, diabetes and those children living with disabilities.

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2019
International Journal of Drug Policy
Stigma Harm Reduction HIV PWID
Attitudes towards people living with HIV and people who inject drugs: A mixed method study of stigmas within harm reduction programs in Kazakhstan

Background: High levels of stigma towards people who inject drugs (PWID) and people living with HIV (PLWH) exist in Kazakhstan, yet little is known about the role of stigma in harm reduction service settings. In this paper, we use a mixed method design to explore and describe the actionable drivers and facilitators of stigma among harm reduction service providers. Additionally, we describe the manifestations of stigma among PWID who are living with HIV (PWID/LWH), and the impact that stigma has on harm reduction and healthcare service utilization.

Methods: Eight focus groups with 57 PWID/LWH were convened between March 2016 and July 2016 to describe manifestations of stigma from the perspective of syringe exchange program (SEP) clients. Additionally, we surveyed 80 nurses, social workers, outreach workers, and providers of HIV care at SEPs between January 2017 and July 2017 to assess stigmatizing attitudes among staff within the SEP environment. Joint displays were used to integrate quantitative and qualitative data.

Results: The actionable drivers of stigma identified in this study include negative opinions and moral judgements towards PWID/LWH. Facilitators identified included stigmatization as a social norm within the service provision environment, a lack of awareness of anti-discrimination policies, and lack of enforcement of antidiscrimination policies. Qualitative findings highlight manifestations of stigma in which PWID/LWH experienced denial of services, perceived negative attitudes, and avoidance from service provision staff. PWID/LWH also described segregation in healthcare settings, the use of unnecessary precautions by providers, and unauthorized disclosure of HIV status.

Conclusions: This paper highlights the urgent need to address stigma in the harm reduction and HIV service settings in Kazakhstan. These findings have implications for informing an actionable model for stigma reduction for providers who deliver services to PWID/LWH in Kazakhstan. Drivers, facilitators, and manifestations of stigma are multifaceted and addressing them will require a multilevel approach.

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2018
International Journal of Drug Policy
Injection drug use People who inject drugs HIV Criminal justice Kazakhstan
Differences by sex in associations between injection drug risks and drug crime conviction among people who inject drugs in Almaty, Kazakhstan

Background: The criminalization of drug use leads to high rates of drug crime convictions for engaging in injection drug use behaviors, introducing barriers to HIV prevention and drug treatment for PWID. Females (FWID) face unique vulnerabilities to HIV compared to males (MWID) in Kazakhstan. This study examined sex differences in associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, and conviction for a drug crime in a sample of people who inject drugs (PWID) in Almaty, Kazakhstan.

Methods: Analyses were performed on baseline data from 510 PWID and stratified by males (MWID) (329) and females (FWID) (181) from Kazakhstan in a couples-focused HIV prevention intervention. Logistic regression analyses using mixed effects (AOR) examined associations between HIV/HCV infection, HIV knowledge, injection drug risk behaviors, drug use severity, drug treatment history and conviction for a drug crime.

Conclusion: High-risk behaviors, HCV infection and more severe substance use disorders are associated with drug crime conviction for PWID, particularly FWID. Structural interventions are necessary to increase the engagement of PWID with drug crime convictions in HIV prevention and substance abuse treatment.

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2018
International Journal of Drug Policy
Opioid overdose HIV HCV Injection drug use
Reducing opioid overdose in Kazakhstan: A randomized controlled trial of a couple-based integrated HIV/HCV and overdose prevention intervention “Renaissance”

Objectives: To evaluate the efficacy of a couple-based integrated HIV/HCV and overdose prevention intervention on non-fatal and fatal overdose and overdose prevention behaviors among people who use heroin or other opioids in Almaty, Kazakhstan.

Methods: We selected 479 participants who reported lifetime heroin or opioid use from a sample of 600 participants (300 couples) enrolled in a randomized controlled trial (RCT) conducted between May 2009 and February 2013. Participants were randomized to either (1) a 5-session couple-based HIV/HCV and overdose prevention intervention condition or (2) a 5-session Wellness Promotion and overdose prevention comparison condition. We used multilevel mixed-effects model with modified Poisson regression to estimate effects of the intervention as risk ratios (RR) and the corresponding 95% CIs.

Results: About one-fifth (21.9%) of the sample reported that they had experienced an opioid overdose in the past 6 months at baseline. At the 12-month follow-up, both the intervention and comparison conditions reported significant reductions in non-fatal overdose and injection heroin/opioid use and significant increases in drug treatment attendance and naloxone use to prevent death from overdose. However, we found no differences between the study arms on any of these outcomes. There were three intervention condition participants (1.3%), compared to seven comparison condition participants (2.9%) who died from opioid overdose during the 12-month follow up period although this difference was not significant.

Discussion: There were no significant conditions on any outcomes: both conditions showed promising effects of reducing non-fatal overdose and overdose risks. Integrating overdose prevention into a couplebased HIV/HCV intervention may be an efficient strategy to target the syndemic of opioid overdose, HIV and HCV in Kazakhstan.

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2017
Министерство здравоохранения Республики Казахстан
HIV/AIDS infectious diseases
Национальный доклад о достигнутом прогрессе в осуществлении глобальных мер в ответ на СПИД Отчетный период: 2017 год

Прекращение эпидемии СПИДа к 2030 году - одна из задач в списке целей устойчивого развития (ЦУР), которая была единогласно принята странами-членами ООН. Полученный опыт в решении проблем ВИЧ-инфекции будет играть определяющую роль в успешном достижении многих ЦУР, в частности, ЦУР 3 («Хорошее здоровье и благополучие»), а также целей касательно вопросов гендерного равенства и расширения прав и возможностей женщин, устранения неравенства между полами, глобального сотрудничества, а также установления принципов справедливости, мира и равноправия в обществе.

Представители от Республики Казахстан приняли активное участие в Совещании высокого уровня Генеральной Ассамблеи ООН по вопросам борьбы со СПИД, которое прошло в Нью-Йорке 8-10 июня 2016 года. Благодаря консолидированной позиции международного сообщества, на совещании высокого уровня, была одобрена Политическая декларация по ВИЧ/СПИДу: ускоренными темпами к активизации борьбы с ВИЧ и прекращению эпидемии СПИДа к 2030 году. Декларация была принята всеми странами-членами ООН, включая Республику Казахстан.

Для достижения целей политической декларации, Объединенная Программа ООН по ВИЧ/СПИД (ЮНЭЙДС) разработала глобальную стратегию «Ускорение: прекращение эпидемии СПИДа к 2030 году», включая достижение целей 909090 к 2020 году.

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2016
Journal of Substance Use
HIV testing and treatment injection drug use Kazakhstan
HIV testing and access to HIV medical care among people who inject drugs and their intimate partners in Kazakhstan

Background: Growing rates of HIV and high rates of injection drug use in Kazakhstan call for examining access to testing and treatment among people who inject drugs and their intimate partners.

Objectives: We examine how access to health and drug treatment services as well as risk environment factors are associated with ever being tested for HIV and ever receiving any general HIV medical care among 728 male and female intimate partners, where at least one partner injects drugs. Methods: Multivariate random effects logistic regression with random effects for couple were conducted to examine associations between access to health and drug treatment services, risk environment factors, and HIV testing and HIV medical care outcomes.

Results: Analyses indicate that accessing needle exchange services and having a regular physician were associated with access to both HIV testing and HIV medical care. Receiving drug treatment was associated with accessing HIV testing but not HIV medical care. Being arrested and charged with a criminal offense was also associated with accessing HIV testing but not HIV medical care.

Conclusions/Importance: Study findings highlight the need for increased scale-up of HIV testing efforts, as well as integrated HIV treatment and care in Kazakhstan.

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2015
Migration Central Asia Sexual risk HIV Masculinity
Masculinities and Social Contexts of HIV Risk Practices Among Central Asian Male Migrant Workers

Background: Migrant workers worldwide are at high risk of acquiring and transmitting HIV and sexually transmitted infections. Over the past decade Central Asia has experienced an increase in new HIV infections and migration and mobility within the region. These trends call for mixed methods research to explore the environmental and mobility contexts in which HIV risk behaviors occur among Central Asian migrants, particularly those in Kazakhstan, a common destination country.

Methods: This study took place in Almaty’s Baraholka Market, which employs 30,000 workers including many migrant workers from Central Asian countries. We used a convenience sampling approach to recruit 48 male migrant workers from Uzbekistan, Tajikistan, Kyrgyzstan, and Kazakhstan. Through in-depth interviews, we examined both their engagement in a number of sexual HIV risk behaviors (including having outside partners, sex trading, and condom use) as well as the meaning they attributed to such behaviors. We also address micro-social contexts (employment, types of relationships, infidelity, and access to resources), macro-contexts (gender roles and power dynamics) and structural contexts (mobility and policing) to examine how environmental influences influenced HIV risks.

Results: Findings suggest that men in this study attributed sex with extramarital partners to sexual desires when wives are unable to have sex, mobility and separation, need for variety, and lack of satisfaction in marriage. Factors influencing condom use included trust, sexual pleasure, intention to protect one’s health, and alcohol use. Participants had low levels of knowledge about HIV/AIDS; believed HIV did not affect their community or social networks, and had limited access to health care.

Conclusions: Study findings call for a combination of contextually sustainable HIV/STI prevention strategies that target migrant workers in Central Asia.

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2014
International Journal of Drug Policy
HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: Implications for HIV prevention, research, and policy

Background: Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIVepidemic, which has historically been driven by injection drug use, but is more recently being fueled byheterosexual transmission.

Methods: This paper examines HIV and HCV infection, as well as sexual and drug-related risks amongfemale partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics.

Results: The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partnersof MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Lessthan one-fifth of all female participants had access to HIV education and services or harm reductionprograms. Although high rates of non-injection drug use and sexual risk behaviors were found amongboth FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIVseropositive (aRR = 3.03; 95% CI = 1.78, 5.18) and HCV seropositive than non-IDU females (aRR = 6.05; 95%CI = 4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR = 1.67; 95% CI = 1.40, 2.00),and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers thatwere not prescribed by a physician (aRR = 17.45; 95% CI = 8.01, 38.01).

Conclusion: Given the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attentionis needed in research, prevention, and policies regarding female partners of male injection drug users.

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2014
Journal of Therapy and Management in HIV Infection
HCV among Male Injection Drug Users and their Female Partners in Almaty, Kazakhstan: Implications for HCV Treatment and Prevention

HCV infection is a serious concern among people who inject drugs. Despite imposing a major disease burden in countries with high rates of injection drug use such as Kazakhstan, other Central Asian and East Asian countries, Eastern Europe, and Russia, HCV remains an understudied issue. This study includes 728 individuals (364 couples) from Almaty, Kazakhstan, where at least one member of the dyad reported recent injection drug use. Participants were recruited to participate in a couple-based HIV prevention study. We examine the prevalence of HCV and co-infections between HCV and HIV, correlates of HCV, and the association between HCV prevalence and sexual behaviors after adjusting for non-injection illicit drug use, unsafe injection behaviors, and socio-demographic characteristics. Of the total sample, 90.2% of people who had ever injected drugs were diagnosed HCV positive and 15.5% of those who did not report injecting drugs were HCV positive. The prevalence of HIV and HCV co-infection among the total sample was 20.7%. In the multivariate analysis, having sex while high on alcohol and/or drugs was associated with HCV after adjusting for unsafe injection practices, non-injection drug use, and socio-demographic characteristics (PR=1.20; 95% CI=1.04, 1.39). The high rates of HCV and co-infection of HIV and HCV found in the study underscore the need for attention to HCV testing and treatment among people who inject drugs in Kazakhstan and their sex partners.

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2013
Drug and Alcohol Dependence
Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: The need for a syndemic approach

Background: Accumulating evidence suggests that opioid overdose and HIV infection are burgeoning intertwined epidemics among people who inject drugs (PWID) in Central Asia. To date, however, research on overdose and its associations with HIV risks among PWID in Central Asia remains virtually absent. This paper aims to provide a regional overview of the hidden epidemic of overdose and how it is linked to HIV among PWID in Central Asia, using a syndemic framework that is guided by risk environment research.

Methods: We conducted a comprehensive literature search of peer-reviewed publications and gray literature on opioid overdose and its associations with HIV in five countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) as well as on policies and programs that address these co-occurring epidemics.

Results: Regional data indicate high rates of fatal and non-fatal overdose among PWID. Evidence suggests mortality rates from overdose exceed HIV/AIDS as the leading cause of death among PWID. The syndemic framework suggests multiple macro-level and micro-level environmental risk factors that drive the cooccurring epidemics of HIV and overdose. This framework identifies several interacting biological and behavioral risks that result in additive effects for HIV and overdose.

Conclusion: The high rates of overdose and its associations with HIV underscore the need for a syndemic approach that considers overdose on parity with HIV. Such an approach should focus on the biological, behavioral and structural interactions between these epidemics to reduce social suffering, morbidity and mortality among PWID in Central Asia.

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2013
Drug and Alcohol Dependence
Tuberculosis, drug use and HIV infection in Central Asia: An urgent need for attention

Introduction: Rates of tuberculosis in Central Asia are extremely high, and even more alarming are the very high rates of multidrug-resistant tuberculosis (MDR-TB) in Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan. In addition, rates of HIV infection related to injection drug use seems to be rising as well, thus creating conditions for a potentially devastating co-epidemic of TB/HIV and MDR-TB/HIV which would have terrible consequences for public health in these countries.

Current status: In many countries of Central Asia, diagnosis of tuberculosis still rests on clinical grounds or simple technologies such as chest radiograph and sputum smear examination. Modern molecular techniques such as GenExpert are being introduced in Kazakhstan and Uzbekistan, and perhaps soon in Kyrgyzstan. Treatment of TB is still often centered around prolonged inpatient stay at TB hospitals. Only a minority of patients with HIV infection are receiving ART, and TB and HIV services are not well integrated. Needle exchange programs are becoming increasingly available, but opioid substitution therapy is rarely used in Central Asia. TB, drug treatment and HIV services are generally not well-integrated.

Conclusions: To combat this developing storm, integration of TB services, HIV care, and substance abuse treatment programs is needed urgently to allow efficient and effective diagnosis and treatment of these conditions in a coordinated manner.

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2013
Drug and Alcohol Dependence
Access to HIV counseling and testing among people who inject drugs in Central Asia: Strategies for improving access and linkages to treatment and care

Introduction: As a population profoundly affected by the HIV epidemic and in critical need of linkages to HIV treatment and care, PWID in Central Asia remain largely underserved. This paper provides an overview of the current state of HIV testing and counseling in Central Asia for PWID, identifies main barriers leading to gaps in service delivery, and discusses implications for improving strategies that promote HIV testing for PWID.

Methods: We reviewed a number of sources for this paper including unpublished government reports, published papers, and Ministries of Health of Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan country progress reports to the UN General Assembly Special Session on HIV/AIDS (UNGASS) for 2012.

Results: Between 29 and 65% of PLWH in some Central Asian countries have been tested for HIV in the last 12 months. The rates have been increasing in the recent years but still are relatively low. Stigma, discrimination, human rights violations, and repressive legislation are barriers to HTC for people who inject drugs (PWID).

Conclusion: The use of innovative evidence-based HTC models, such as community mobile-vans, selftesting at home, and rapid HIV testing among PWID in Central Asia are discussed and recommendations given regarding amendments in legislation and scaling up of existing community-based pilot projects to support HIV testing among PWID in CA.

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2012
Assel Terlikbayeva
Sabrina Hermosilla
Sandro Galea
Tuberculosis Case notification rate (CNR) Prevalence Risk factors MDR-TB Kazakhstan Spatial distribution Surveillance National tuberculosis program (NTP) Oblast
Tuberculosis in Kazakhstan: analysis of risk determinants in national surveillance data

Background: Development of tuberculosis (TB) is determined by various risk factors and the interactions of temporal and spatial distributions. The aim of this study was to identify the most salient risk factors for TB disease as well as multidrug resistant TB (MDR-TB) at the oblast (provincial) level in Kazakhstan. 

Methods: Correlational and descriptive analyses were conducted at the oblast and national level using data provided by the country’s National Institute of Geography (NIG) and the National Tuberculosis Program (NTP).  Reported incident case notification rates (CNRs) and prevalence vary by oblast, thus the study investigated which determinants contributed to this regional variation and compared burdens among oblasts.

Results: The results showed that while tuberculosis CNRs decreased over the study period, MDR-TB conversely increased. Two oblasts -Atyrauskaya and Mangystauskaya - presented especially significant anomalies with large
decreases in TB incident CNRs coupled with comparatively large increases in MDR-TB incident CNRs.

Conclusion: Understanding the distribution of TB and MDR-TB cases and associated risk factors, especially the “unknown risk factor” categorization points to the need for future research.

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