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Accelerating Progress towards Ending TB/MDR-TB and Strengthening the Operational Research Capacity of the National Tuberculosis Control Program in Kyrgyzstan

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A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (10 June 2023) | Viewed by 13511

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Special Issue Editors

Dr. Ermias Diro

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Guest Editor

School of Medicine, University of Washington, Seattle, WA, USA
Interests: tuberculosis; tropical infectious diseases

Prof. Dr. Sven Gudmund Hinderaker

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Guest Editor

Centre for International Health, University of Bergen, Bergen, Norway
Interests: tuberculosis; tropical medicine and infectious diseases

Special Issue Information

Dear Colleagues,

In order to attain the End Tuberculosis (End-TB) targets of 95% reduction in number of tuberculosis (TB) deaths and 90% reduction in tuberculosis incidence by 2035, the case-finding and management of tuberculosis will have to better address hard-to-reach and vulnerable populations that often lie outside the mainstream of health systems. The WHO’s Global Plan to End TB aims to ensure that TB diagnostic and treatment services reach at least 90% of such populations and that at least 90% of them achieve treatment success. Focusing on hard-to-reach and vulnerable populations will enhance equity and contribute to achieving Universal Health Coverage for TB, “leaving no one behind”.

The articles in this Special Issue reflect a collaborative effort to build sustainable operational research capacity to improve case finding, diagnosis and treatment of TB and multi-drug-resistant TB (MDR-TB) in Kyrgyzstan. The publications in this series addressed national research priorities, were led by national investigators and importantly, involved regional and international collaborative partnerships, reflecting the philosophy, “thinking global but acting local”.

The project was funded by USAID and used the Structured Operational Research and Training IniTiative (SORT IT), a global operational research partnership led by TDR, The Special Programme for Research and Training hosted at the World Health Organisation. More on SORT IT is available here https://tdr.who.int/activities/sort-it-operational-research-and-training.

It is encouraging to see a critical mass of trained operational researchers in Kyrgyzstan who can now use their acquired SORT IT skills to make the country “data rich, information rich and action rich” in tackling TB/MDR-TB and other health system challenges to improve public health.

Dr. Ermias Diro
Prof. Dr. Sven Gudmund Hinderaker
Guest Editors

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Keywords

health systems strengthening
universal health care
SDGs
SORT IT
End-TB
public health systems research

Published Papers (9 papers)

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Editorial

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5 pages, 531 KiB

Open AccessEditorial

Strengthening the Operational Research Capacity of National Tuberculosis Control Programs: Necessity or Luxury?

by Rony Zachariah, Olga Goncharova, Chynara Kamarli, Timur Bazikov, Sevim Ahmedov, Kudaibergen Osmonaliev, Anthony D. Harries, Hayk Davtyan, Pruthu Thekkur, Gulmira Kalmambetova and Abdullaat Kadyrov

Trop. Med. Infect. Dis. 2023, 8(7), 339; https://doi.org/10.3390/tropicalmed8070339 - 25 Jun 2023

Viewed by 1032

Abstract

‘How to get research into practice: first get practice into research [...] Full article

(This article belongs to the Special Issue Accelerating Progress towards Ending TB/MDR-TB and Strengthening the Operational Research Capacity of the National Tuberculosis Control Program in Kyrgyzstan)

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Research

Jump to: Editorial

11 pages, 510 KiB

Open AccessArticle

Quality of Electronic TB Register Data Compared with Paper-Based Records in the Kyrgyz Republic

by Daniil Shauer, Ofelya Petrosyan, Manik Gemilyan, Edward M. Kamau, Pruthu Thekkur, Olga Goncharova, Kalmambetova Gulmira, Bolot Kyrbashov, Kylychbek Istamov, Meder Kadyrov and Ewan Wilkinson

Trop. Med. Infect. Dis. 2023, 8(8), 416; https://doi.org/10.3390/tropicalmed8080416 - 16 Aug 2023

Viewed by 1337

Abstract

This study evaluated the effectiveness of an electronic system for managing individuals with drug-sensitive pulmonary tuberculosis in the Kyrgyz Republic. This cohort study used programmatic data. The study included people registered on the paper-based system in 2019 and 302 people registered on both the electronic and the paper-based systems between June 2021 and May 2022. The data from the 302 individuals were used to assess the completeness of each form of record and the concordance of the electronic record with the paper-based system. This study showed that for most variables, the completeness and concordance were 85.3–93.0% and were lowest for nonmandatory fields such as medication side effects (26.8% vs. 13.6%). No significant difference was observed in the time taken from symptom onset to diagnosis and treatment initiation between the two systems. However, the electronic system had a significantly higher percentage of subjects who initiated treatment on the day of diagnosis (80.3% vs. 57.1%). The proportion with successful outcomes was similar in both groups, but the electronic system had a significantly lower proportion of individuals with outcomes that were not evaluated or recorded (4.8% vs. 14.3%, p < 0.001). This study highlights the potential advantages and gaps associated with implementing an electronic TB register system for improving records. Full article

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12 pages, 550 KiB

Open AccessArticle

Delays in Treatment Initiation and Treatment Outcomes in Patients with Tuberculosis in the Kyrgyz Republic: Are There Differences between Migrants and Non-Migrants?

by Kylychbek Istamov, Mher Beglaryan, Olga Goncharova, Konushbek Sakmamatov, Bolot Kyrbashov, Mukadas Mamytova, Indira Zairova, Gulzat Alumkylova and Divya Nair

Trop. Med. Infect. Dis. 2023, 8(8), 412; https://doi.org/10.3390/tropicalmed8080412 - 13 Aug 2023

Viewed by 1002

Abstract

Migrants are at increased risk of developing tuberculosis (TB) and have poor treatment outcomes. The National TB program (NTP) of the Kyrgyz Republic recognizes two types of migrants: internal (intra-country) and external (inter-country) migrants. This cohort study compared the characteristics, timeliness of diagnosis and treatment initiation, and treatment outcomes of TB patients (internal migrant vs. external migrant vs. non-migrant) identified during treatment in the country in 2021. The TB treatment register and treatment cards of 5114 patients (156 internal, 430 external, and 4528 non-migrants) were reviewed. Risk factors (unemployment, smoking, alcohol use, and homelessness) were higher (p-value < 0.001) in internal (84%) than in external migrants (66%) and non-migrants (43%). The median delay in seeking care post-symptom onset was longer (p-value= 0.03) in external (30 days) than in internal migrants (21 days) and non-migrants (25 days). Successful treatment outcomes for drug-sensitive TB were higher in internal (89%, p-value = 0.012) and external migrants (86%, p-value = 0.001) than in non-migrants (78%). Internal and external migrants should be separately considered with respect to TB care and monitoring under the NTP. Success rates seem to be high in migrants, but our findings may be biased, as migrants with poor healthcare access may remain undetected and untreated and have undocumented poor outcomes. Full article

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11 pages, 253 KiB

Open AccessArticle

Time to Treatment and Risk Factors for Unsuccessful Treatment Outcomes among People Who Started Second-Line Treatment for Rifampicin-Resistant or Multi-Drug-Resistant Tuberculosis in the Kyrgyz Republic, 2021

by Bolot Kyrbashov, Aizat Kulzhabaeva, Abdullaat Kadyrov, Atyrkul Toktogonova, Collins Timire, Srinath Satyanarayana and Kylychbek Istamov

Trop. Med. Infect. Dis. 2023, 8(8), 407; https://doi.org/10.3390/tropicalmed8080407 - 10 Aug 2023

Viewed by 1187

Abstract

The Kyrgyz Republic is a high-burden country for rifampicin resistant/multi-drug resistant tuberculosis (RR/MDR-TB). TB control efforts rely on early diagnosis and initiation of people on effective regimens. We studied the interval from diagnosis of RR-TB to starting treatment and risk factors for unsuccessful outcomes among people who started RR/MDR-TB treatment in 2021. We conducted a cohort study using country-wide programme data and used binomial regression to determine associations between unsuccessful outcomes and predictor variables. Of the 535 people included in the study, three-quarters were in the age category 18–59 years, and 68% had past history of TB. The median (IQR) time from onset of TB symptoms to diagnosis was 30 (11–62) days, 1 (0–4) days from diagnosis to starting treatment, and 35 (24–65) days from starting treatment to receipt of second-line drug susceptibility test (SL-DST) results. Overall, 136 (25%) had unsuccessful outcomes. Risk factors for unsuccessful outcomes were being homeless, fluroquinolone resistance, having unknown HIV status, past TB treatment, male gender and being unemployed. Treatment outcomes and the interval from diagnosis to starting treatment were commendable. Further reductions in unsuccessful outcomes by be achieved through ensuring timely diagnosis and access to SL-DSTs and by reducing the proportion of people who are lost to follow-up. Full article

16 pages, 1236 KiB

Open AccessArticle

The Trend, Characteristics and Treatment Outcomes in Patients with Tuberculosis Undergoing Thoracic Surgery in the Kyrgyz Republic between 2017 and 2021

by Konushbek Sakmamatov, Yulia Kuznetsova, Kylychbek Istamov, Daniil Shauer, Jaya Prasad Tripathy, Anthony D. Harries, Kudaibergen Osmonaliev and Olga Goncharova

Trop. Med. Infect. Dis. 2023, 8(8), 393; https://doi.org/10.3390/tropicalmed8080393 - 31 Jul 2023

Viewed by 843

Abstract

Surgery has played an important role in managing complicated tuberculosis in former Soviet Union countries, including the Kyrgyz Republic. However, published information is limited. This study aimed to document the trend, characteristics and outcomes of tuberculosis patients who underwent thoracic surgery, using routinely collected data. Between 2017 and 2021, 4–7% of tuberculosis patients in the Kyrgyz Republic underwent thoracic surgery in two centres in Bishkek and Osh. In 2021, case records were retrieved in 264 (78%) of 340 patients undergoing thoracic surgery in the country. The most common indications for surgery were pleural exudate/empyema in 127 (44%) and tuberculoma in 83 (32%). Most patients (73%) underwent surgery within 30 days of starting TB treatment. Two-thirds of patients underwent radical surgery, and surgical outcomes were excellent in 99% of patients with one death. Post-operatively, 63 (23%) patients had no TB detected by the histology, with the two most common specified conditions being lung cancer and pulmonary hydatid disease. TB treatment was stopped in these patients. Of the 201 patients with confirmed TB after surgery, TB-treatment success was documented in 163 (81%), died/failure/lost to follow-up in 10 (5%) and not evaluated in 28 (14%). This study shows that thoracic surgery is feasible, safe and effective in the routine programme setting. Recommendations are made to strengthen referral and monitoring systems. Full article

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13 pages, 689 KiB

Open AccessArticle

Triple Priority: TB/HIV Co-Infection and Treatment Outcomes among Key Populations in The Kyrgyz Republic: A National Cohort Study (2018–2022)

by Olga Goncharova, Arpine Abrahamyan, Divya Nair, Mher Beglaryan, Aibek Bekbolotov, Elena Zhdanova, Abdullaat Kadyrov and Rony Zachariah

Trop. Med. Infect. Dis. 2023, 8(7), 342; https://doi.org/10.3390/tropicalmed8070342 - 27 Jun 2023

Viewed by 1280

Abstract

Background: Improving tuberculosis (TB) care in key populations is an operational research priority in the Kyrgyz Republic. Here, we describe the characteristics of TB/HIV co-infected individuals, their affiliations with key country-wide population groups, and their TB treatment outcomes. Methods: This was a cohort study using national programmatic data (2018–2022). The key population groups included people with increased exposure to TB, limited access to TB services, and increased risk of acquiring TB. Results: Among 693 individuals with TB/HIV co-infection, the majority (58%) of individuals were from two regions of the Kyrgyz Republic (Chui and Bishkek). Eighty-four percent (84%) individuals had one or more affiliations to eight key population groups, with 49% of the individuals affiliated to ≥2 groups and 92% of the individuals were on both antiretroviral treatment and cotrimoxazole preventive therapy. Overall, 406 (59%) of the individuals had successful outcomes and 287 (41%) of the individuals had unsuccessful outcomes. Unsuccessful outcomes increased from 36% (n-39) with TB/HIV alone to 47% (n-86) with affiliations to ≥3 key population groups (P-0.03). Unsuccessful outcomes were associated with co-morbidities (diabetes mellitus and hepatitis B/C), migration, alcohol use, and extrapulmonary TB. Conclusions: For a long time, people with TB/HIV co-infection have been recognized as a “double priority”. Affiliation to key populations accentuates their status to “triple priority”. We advocate for increased attention and equity towards these populations. Full article

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12 pages, 256 KiB

Open AccessEditor’s ChoiceArticle

Discharge Outcomes of Severely Sick Patients Hospitalized with Multidrug-Resistant Tuberculosis, Comorbidities, and Serious Adverse Events in Kyrgyz Republic, 2020–2022

by Gulzat Alumkulova, Anna Hazoyan, Elena Zhdanova, Yuliia Kuznetsova, Jaya Prasad Tripathy, Aelita Sargsyan, Olga Goncharova, Meder Kadyrov, Kylychbek Istamov and Nimer Ortuño-Gutiérrez

Trop. Med. Infect. Dis. 2023, 8(7), 338; https://doi.org/10.3390/tropicalmed8070338 - 25 Jun 2023

Viewed by 1948

Abstract

Patients with multidrug-resistant tuberculosis (MDR-TB) who have comorbidities, complications, and experience serious adverse events (SAEs) are at substantial risk of having unfavorable hospital outcomes. We assessed characteristics and discharge outcomes of 138 MDR-TB patients hospitalized in the National Referral Center of Bishkek, Kyrgyz Republic, from January 2020 to August 2022. The main clinical characteristics included pulmonary complications (23%), malnutrition (33%), severe anemia (17%), diabetes mellitus (13%), viral hepatitis B and C (5%), and HIV infection (3%). Of those patients, 95% were successfully managed and discharged from hospital. Seven patients had unfavorable discharge outcomes (three patients died and four had a worsened clinical condition). Comorbidities (diabetes, and/or HIV), severe anemia, pulmonary complications, cardiovascular disorders, alcohol abuse, and SAEs were associated with unfavorable discharge outcomes. Sixty-five percent of the patients had SAEs, with electrolyte imbalance (25%), gastrointestinal disease (18%), hepatotoxicity (16%), and anemia (14%) being the most frequent. Successful resolution occurred in 91% of patients with SAEs. In summary, our study documented that sick patients who were hospitalized with MDR-TB were well managed and had good hospital discharge outcomes, despite the fact that they had comorbidities, complications, and SAEs. This information should assist in the referral and management of such patients in the future. Full article

14 pages, 699 KiB

Open AccessArticle

Contact Tracing and Tuberculosis Preventive Therapy for Household Child Contacts of Pulmonary Tuberculosis Patients in the Kyrgyz Republic: How Well Are We Doing?

by Meder Kadyrov, Pruthu Thekkur, Evgenia Geliukh, Aelita Sargsyan, Olga Goncharova, Aizat Kulzhabaeva, Asel Kadyrov, Mohammed Khogali, Anthony D. Harries and Abdullaat Kadyrov

Trop. Med. Infect. Dis. 2023, 8(7), 332; https://doi.org/10.3390/tropicalmed8070332 - 21 Jun 2023

Cited by 2 | Viewed by 2336

Abstract

Early identification, screening and investigation for tuberculosis (TB), and provision of TB preventive therapy (TPT), reduces risk of TB among child household contacts of pulmonary TB patients (index patients). A cohort study was conducted to describe the care cascade and timeliness of contact tracing and TPT initiation among child household contacts (aged < 15 years) of index patients initiated on TB treatment in Bishkek, the Kyrgyz Republic during October 2021–September 2022. In the register, information on the number of child household contacts was available for 153 (18%) of 873 index patients. Of 297 child household contacts identified, data were available for 285, of whom 261 (92%) were screened for TB. More than 50% were screened after 1 month of the index patient initiating TB treatment. TB was diagnosed in 23/285 (9%, 95% CI: 6–13%) children. Of 238 TB-free children, 130 (55%) were eligible for TPT. Of the latter, 64 (49%) were initiated on TPT, of whom 52 (81%) completed TPT. While TPT completion was excellent, there was deficiency in contact identification, timely screening and TPT initiation. Thus, healthcare providers should diligently request and record details of child household contacts, adhere to contact tracing timelines and counsel caregivers regarding TPT. Full article

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14 pages, 1026 KiB

Open AccessArticle

“Together against Tuberculosis”: Cascade of Care of Patients Referred by the Private Health Care Providers in the Kyrgyz Republic

by Dinara Madybaeva, Aiymgul Duishekeeva, Anna Meteliuk, Aizat Kulzhabaeva, Abdullaat Kadyrov, Natalia Shumskaia and Ajay M. V. Kumar

Trop. Med. Infect. Dis. 2023, 8(6), 316; https://doi.org/10.3390/tropicalmed8060316 - 10 Jun 2023

Viewed by 1615

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. Full article

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Accelerating Progress towards Ending TB/MDR-TB and Strengthening the Operational Research Capacity of the National Tuberculosis Control Program in Kyrgyzstan

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