Interactive effects of aridity and local environmental factors on the functional trait composition and diversity of macroinvertebrate assemblages in dryland rivers.

Drought and local habitat alteration are major environmental stressors shaping the aquatic biota in dryland rivers. However, the combined effects of these factors on aquatic biodiversity remain poorly understood. We collected macroinvertebrate data from Central Asian dryland rivers in Xinjiang, China, from 2012 to 2022, to investigate the individual and interactive effects of drought (as indicated by increasing values of Aridity, AI) and local habitat conditions (fine sediments, velocity and pH) on aquatic macroinvertebrate functional trait composition and diversity. We found that interactions of the selected environmental stressors exhibited more frequent additive than synergistic or antagonistic effects, leading to shifts in macroinvertebrate functional trait composition and diversity accordingly. Interaction of AI and fine sediments showed more pronounced synergistic effects (positive or negative) compared to others and had positive influences on traits like small body size, ovoviviparity, etc. Functional diversity metrics responded differently to stressor interactions, with FRic and FDis being negatively affected, whereas FEve was positively correlated to stressor interaction, suggesting the complementary roles of functional diversity metrics to diagnose impacts of stressor interactions. Overall, our study provides new insights into macroinvertebrate assemblage-stressor relationships in dryland rivers and can help better assess, predict and manage aquatic biodiversity in these rivers under ongoing environmental change.

Medical Education Challenges in the Era of Internationalization and Digitization.

Prior to the coronavirus disease 2019 (COVID-19) pandemic, Central Asia and Eastern Europe saw a significant rise in international medical student enrollment, driven by competitive tuition fees, prestigious institutions, and culturally diverse environments. The pandemic forced a rapid shift to online learning, disrupting student mobility and compromising clinical training quality. Online education for international medical students during the COVID-19 pandemic has proven beneficial, though low- and middle-income countries struggled with access to information infrastructure and resources. While 64% of students preferred online learning, challenges like limited internet access and lack of in-person interaction persisted, making a blended approach of online and traditional methods most effective. Despite a rebound in post-pandemic enrollment, persistent challenges such as linguistic obstacles, psychological stress, and cultural adaptation issues remain. Active research engagement during undergraduate studies is essential for skill development. Integrating research into education curricula and fostering motivation are crucial for enhancing academic outcomes. Critical thinking and cultural competence are vital, necessitating explicit instruction and collaborative learning strategies. Addressing language barriers through comprehensive support systems for both instructors and students is imperative. Tailored strategies and robust institutional support are essential to enhancing the educational experiences and success of international medical students.

How likely are Eastern European and central Asian countries to achieve global NCD targets: multi-country analysis.

BACKGROUND: In Europe, mortality rates from noncommunicable diseases (NCDs) among persons 30-69 years of age ("NCD premature mortality rates") have declined significantly, except in twelve countries of Eastern Europe and Central Asia, namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Data on long-term trends in NCD mortality in these countries are limited. We analyzed NCD premature mortality rates, identified change points in NCD mortality trends and forecasted how likely countries are to achieve the global NCD targets, stratified by gender and NCD type. METHODS: We used the 1990-2019 Global Burden of Disease database to analyze NCD trends and identified country-specific change points by using piecewise linear regression. We assessed the likelihood of achieving the global targets for reducing NCD premature mortality rates among persons 30-69 years of age from four NCDs: cancers, diabetes, cardiovascular and chronic respiratory diseases. The global NCD targets are 25% reduction in mortality from 2010 to 2025 (WHO 25X25 target) and 33%-from 2015 to 2030 (SDG 3.4.1). We applied the analysis to both genders and four NCDs. RESULTS: Only Kazakhstan and Russia are likely to achieve the global NCD targets. For Kazakhstan, WHO 25X25 and SDG 3.4.1 global targets for mortality rates were 494.3 and 374.8 per 100,000 population respectively; the corresponding predicted values (PVs) were 360.6 [CI 260.1-461.1] and 245.1 [CI 113.4-376.8]. For Russia, WHO 25X25 and SDG 3.4.1 global targets were 560.5 and 442.8 per 100,000 population respectively; the corresponding PVs were 427.7 [CI 270.3-585.1] and 311.0 [CI 102.8-519.1]. Achieving NCD global targets is less likely for Kyrgyzstan, while it is unlikely for the rest of countries. Most countries had higher mortality rates and slower progress among men compared with women. The likelihood of achieving overall global NCD targets was mainly explained by reduction in cardiovascular mortality. CONCLUSIONS: In most Eastern Europe and Central Asia countries, progress towards achieving NCD global targets is slow, or there's a reverse trend. Further quantitative and qualitative research is needed to understand the underlying reasons. Separate indicators are needed to monitor trends for cancers, diabetes and chronic respiratory diseases.

Sustainability of opioid agonist therapy programmes in Belarus, the Republic of Moldova, Tajikistan and Ukraine in the context of transition from Global Fund support during 2020-2023.

BACKGROUND: Most national programmes of opioid agonist therapy (OAT) in Eastern Europe and Central Asia are at a critical juncture for building their sustainability due to decreasing support from the Global Fund and other international HIV funders. Therefore, it is timely to identify the status, trends, opportunities and risk factors of OAT preparedness in the face of donor transition. METHODS: The study assessed the OAT sustainability progress in 4 countries: Belarus, the Republic of Moldova, Tajikistan and Ukraine. The study used a comparative country case study design with qualitative methods and two data points in 2020 and 2022-2023. In total, 363 sources were reviewed and used, 83 interviews with key informants and 13 focus groups were conducted with clients, using a joint methodology and a defined Framework with three dimensions: 'Policy & Governance'; 'Finance & Resources'; and, 'Services'. RESULTS: All four countries have made improvements to increase OAT sustainability, though it varied. In 2022, Ukraine had a substantial degree of sustainability, followed by Belarus and Moldova with a moderate degree, while Tajikistan's sustainability was at moderate-to-high risk. No country achieved a high degree of OAT sustainability in any of the three dimensions measured. However, a high degree of sustainability was reported for at least one indicator in Belarus, Moldova and Ukraine: 'Medicines'; 'Financial resources'; 'Evidence and information systems'; 'Service Accessibility'; or, 'Service integration & quality'. On average, the greatest improvement between 2020 and 2022 was seen for 'Availability & coverage'; 'Financial resources'; 'Service quality & integration'; and, 'Service accessibility'. The highest risks across the countries, notably in Belarus and Tajikistan, were recorded for the indicator, 'Availability and coverage'. Of concern is that the least progress, or even a decline, was found in 'Human resources'. CONCLUSIONS: OAT sustainability in the 4 analysed countries remains at risk, despite progress in all countries. Managing HIV donor transition can have positive effects in addressing financial sustainability, especially inspired by Ukraine's continued progress despite economic contraction and Russia's invasion. More attention is needed to non-financial aspects of OAT sustainability in donor transition planning. The directions that could have multifaceted positive influence for OAT long-term resilience and scale up for impact on drug problems include decentralisation outside of health settings and broader drug treatment financial and management transformation, together with drug policy reforms. Thus far, viable solutions for sustainability of OAT in conflict areas appear unlikely. Building OAT resilience should remain high on the agenda of national stakeholders, technical partners and donors.

Environmental and Climatic Drivers of Phytoplankton Communities in Central Asia.

Artificial water bodies in Central Asia offer unique environments in which to study plankton diversity influenced by topographic barriers. However, the complexity of these ecosystems and limited comprehensive studies in the region challenge our understanding. In this study, we systematically investigated the water environment parameters and phytoplankton community structure by surveying 14 artificial waters on the southern side of the Altai Mountains and the northern and southern sides of the Tianshan Mountains in the Xinjiang region. The survey covered physical and nutrient indicators, and the results showed noticeable spatial differences between waters in different regions. The temperature, dissolved oxygen, total nitrogen, and total phosphorus of artificial water in the southern Altai Mountains vary greatly. In contrast, the waters in the northern Tianshan Mountains have more consistent physical indicators. The results of phytoplankton identification showed that the phytoplankton communities in different regions are somewhat different, with diatom species being the dominant taxon. The cluster analysis and the non-metric multidimensional scaling (NMDS) results also confirmed the variability of the phytoplankton communities in the areas. The variance partitioning analysis (VPA) results showed that climatic and environmental factors can explain some of the variability of the observed data. Nevertheless, the residual values indicated the presence of other unmeasured factors or the influence of stochasticity. This study provides a scientific basis for regional water resource management and environmental protection.

Population genetic insights into the conservation of common walnut (Juglans regia) in Central Asia.

The common walnut (Juglans regia) is one of the most economically important nut trees cultivated worldwide. Despite its importance, no comprehensive evaluation of walnut tree population genetics has been undertaken across the range where it originated, Central Asia. In this study, we investigated the genetic diversity and population structure of 1082 individuals from 46 populations across Central Asia. We found moderate genetic diversity of J. regia across Central Asia, with 46 populations clustered into three groups with a weak relationship between genetic and geographic distance. Our findings reveal that the western Himalaya might be the core region of common walnut genetic diversity in Central Asia and that, except for two populations in Gongliu Wild Walnut Valley, humans might have introduced walnut populations to Xinjiang, China. The observed distribution of the genetic landscape has probably been affected by historical climate fluctuation, breeding system, and prolonged anthropogenic activity. We propose the conservation of the core genetic diversity resources in the western Himalaya and pay special attention to populations from Gongliu in Xinjiang. These findings enhance our understanding of the genetic variation throughout the distribution range of J. regia in Central Asia, which will provide a key prerequisite for evidence-based conservation and management.

A greater negative impact of future climate change on vegetation in Central Asia: Evidence from trajectory/pattern analysis.

In the context of global warming, vegetation changes exhibit various patterns, yet previous studies have focused primarily on monotonic changes, often overlooking the complexity and diversity of multiple change processes. Therefore, it is crucial to further explore vegetation dynamics and diverse change trajectories in this region under future climate scenarios to obtain a more comprehensive understanding of local ecosystem evolution. In this study, we established an integrated machine learning prediction framework and a vegetation change trajectory recognition framework to predict the dynamics of vegetation in Central Asia under future climate change scenarios and identify its change trajectories, thus revealing the potential impacts of future climate change on vegetation in the region. The findings suggest that various future climate scenarios will negatively affect most vegetation in Central Asia, with vegetation change intensity increasing with increasing emission trajectories. Analyses of different time scales and trend variations consistently revealed more pronounced downward trends. Vegetation change trajectory analysis revealed that most vegetation has undergone nonlinear and dramatic changes, with negative changes outnumbering positive changes and curve changes outnumbering abrupt changes. Under the highest emission scenario (SSP5-8.5), the abrupt vegetation changes and curve changes are 1.7 times and 1.3 times greater, respectively, than those under the SSP1-2.6 scenario. When transitioning from lower emission pathways (SSP1-2.6, SSP2-4.5) to higher emission pathways (SSP3-7.0, SSP5-8.5), the vegetation change trajectories shift from neutral and negative curve changes to abrupt negative changes. Across climate scenarios, the key climate factors influencing vegetation changes are mostly evapotranspiration and soil moisture, with temperature and relative humidity exerting relatively minor effects. Our study reveals the negative response of vegetation in Central Asia to climate change from the perspective of vegetation dynamics and change trajectories, providing a scientific basis for the development of effective ecological protection and climate adaptation strategies.

Informing policy with health labour market analysis to improve availability of family doctors in Tajikistan.

BACKGROUND: Tajikistan has embarked on health reforms to orient the health system towards primary health care (PHC). The health labour market analysis (HLMA) was initiated by the Ministry of Health with the World Health Organization (WHO) on policy questions related to the PHC workforce team. This article presents the results with focus on family doctors as a critical part of the PHC team, providing lessons for strengthening family medicine and PHC in the European Region and central Asia. METHODS: The HLMA framework was used to guide the analysis. The data for analysis were provided by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Descriptive means were used to analyse the data. A Technical Working Group guided the process. RESULTS: There has been an increase in the number of health workers in the country over the last 7 years. However, there is a huge shortage of family doctors when compared with norms, with decreasing family doctor densities over the last 7 years. Family doctors have the highest vacancy rates among specialists and also constitute the highest proportion of specialists who migrate. There is inequitable distribution of doctors across the regions. Overall number of enrolments and graduates in family medicine are declining. Although salaries in PHC are higher than in hospitals, the overall health workforce salaries are lower than the national average. While there have been efforts to retain and attract doctors to PHC in rural and remote regions, challenges exist. The attraction of doctors to narrow specialties may be leading to undermining PHC and family medicine. While the optimal skill-mix and availability of nurses provide an opportunity to strengthen multi-disciplinary teams at the PHC level, shortages and unequal distribution of doctors are affecting health services coverage and health indicators. CONCLUSIONS: Application of the HLMA framework has helped identify the bottlenecks in the health labour market flows and the possible explanations for them. The policy considerations emerging out of the HLMA have contributed to improving evidence-based planning for retention and recruitment of the PHC workforce, improvements in medical and nursing education, and higher investments in the PHC workforce and particularly in family doctors. Implementation of the Action Plan will require political commitment, financial resources, strong inter-sectoral collaboration, stakeholder management, and cross-country learning of best practices. Through this process, Tajikistan has shown the way forward in implementing the Central Roadmap for health and well-being in Central Asia and the Framework for Action on the Health and Care Workforce in the WHO European Region.

Regionwide and Nationwide Floristic Richness Reveal Vascular Plant Diversity in Central Asia.

Central Asia (CA) is located in the interior of the Eurasian continent and consists of five countries-Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. It contains the largest concentration of temperate deserts and mountains of CA biodiversity hotspots. However, regionwide floristic diversity is sorely lacking, and nationwide floristic diversity is seriously outdated in this region. Using the data collected by the Mapping Asia Plants (MAP) project, we describe and analyze the diverse floristic characteristics of plant diversity in CA at both the regional and national levels, including the dominant families and genera, endemic taxa, and floristic similarity. The results allow the compilation of a new checklist of vascular plants in CA, including 9643 taxa (1198 genera within 139 families) and 3409 endemic taxa (414 genera in 66 families). We confirm that there are 5695, 4036, 4542, 3005, and 4222 species of vascular plants within the CA countries, of which 532, 326, 505, 175, and 301 species are endemic taxa in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan, respectively. The region's biodiversity is notable for its high degree of endemism-up to 35.35%-which contributes to the floristic uniqueness and the irreplaceability of CA. Tajikistan, encompassing the most dominant area of the CA mountains, has the highest species density (3.19/100 km2) and endemism (11.12%) among the five countries. Neighboring countries such as Tajikistan and Uzbekistan, and Kazakhstan and Kyrgyzstan share more species in common, while Turkmenistan has less species overlap with the other four countries. Trends in endemic and total taxa are consistent. This comprehensive inventory is novel, revealing CA's plant diversity in two dimensions and providing a solid foundation for subsequent research that will be beneficial to the transboundary conservation and sustainable use of plant resources in CA.

Surveillance Metrics and History of the COVID-19 Pandemic in Central Asia: Updated Epidemiological Assessment.

BACKGROUND: This study updates the COVID-19 pandemic surveillance in Central Asia we conducted during the first year of the pandemic by providing 2 additional years of data for the region. The historical context provided through additional data can inform regional preparedness and early responses to infectious outbreaks of either the SARS-CoV-2 virus or future pathogens in Central Asia. OBJECTIVE: First, we aim to measure whether there was an expansion or contraction in the pandemic in Central Asia when the World Health Organization (WHO) declared the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aim to provide historical context for the course of the pandemic in Central Asia. METHODS: Traditional surveillance metrics, including counts and rates of COVID-19 transmissions and deaths, and enhanced surveillance indicators, including speed, acceleration, jerk, and persistence, were used to measure shifts in the pandemic. To identify the appearance and duration of variants of concern, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. RESULTS: Speed for the region had remained below the outbreak threshold for 7 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant, the coefficients were relatively small in magnitude (0.125 and 0.347, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, were both significant and negative, meaning the clustering effect of new COVID-19 cases became even smaller in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became entirely insignificant for the first time in March 2023. CONCLUSIONS: Although COVID-19 continues to circulate in Central Asia, the rate of transmission remained well below the threshold of an outbreak for 7 months ahead of the WHO declaration. COVID-19 appeared to be endemic in the region and no longer reached the threshold of a pandemic. Both standard and enhanced surveillance metrics suggest the pandemic had ended by the time of the WHO declaration.

Typologies of Sex Work Practice and Associations with the HIV Risk Environment and Risk Behaviors in Kazakhstan.

Women engaged in sex work (WESW) who use drugs are a key population in Kazakhstan's HIV epidemic. Global research suggests susceptibility to HIV varies by sex work environment. This study aims to identify evidence-based typologies of WESW and examine their associations with HIV risk. We surveyed 400 WESW who use drugs in two Kazakhstani cities, including questions on sociodemographic characteristics, social, physical, and economic risk environments, and sexual risk behaviors. Latent class analysis identified four distinct typologies of sex work practice: occasional sex work (n = 61, 15%), professional sex work for money (n = 187, 47%), sex work in exchange for drugs, goods, or other services (n = 117, 29%), and managed sex work under a boss/pimp/madam (n = 35, 9%). We then used logistic regression to examine associations between typologies and risk behaviors. Compared to professional sex work, occasional sex work was associated with lower odds of multiple sexual partners (aOR:0.46[95%CI:0.24,0.90]), of multiple paid clients (aOR:0.25[0.13,0.49]), and of > 1 instance of unprotected sex with a paying partner (aOR:0.33[0.17,0.63]). Compared to professional sex work, sex work for nonmonetary items was associated with higher odds of multiple sexual partners (aOR:1.85[0.96,3.67]) and of > 1 instance of unprotected sex with a paying partner (aOR:1.71[1.01,2.93]). Results suggest heterogeneity among WESW who use drugs in Kazakhstan, and that typologies of sex work are associated with varying HIV risk environment factors and risk behaviors. Effective HIV prevention efforts must be tailored to address these varying risk environments and the resulting variety of needs.

Being yourself is a defect: analysis of documented rights violations related to sexual orientation, gender identity and HIV in 2022 using the REAct system in six eastern European, Caucasus and Central Asian countries.

INTRODUCTION: Removing legal barriers to HIV services is crucial for the global 2030 goal of ending the HIV and AIDS epidemic, particularly in eastern Europe, the Caucasus and central Asia. Despite state commitments to uphold human rights, gay, bisexual and other men who have sex with men (gbMSM), along with transgender people (TP) still face stigma and discrimination. This article presents an analysis of rights violations based on sexual orientation and gender identity (SOGI) and HIV reported in 2022 across six countries, highlighting features and their links to legislation and law enforcement practices. METHODS: We examined documented cases of rights violations among gbMSM and TP in Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Ukraine in 2022 using the REAct system, a tool for documenting and responding to rights violations against key populations. Initially, we employed directed content analysis based on Yogyakarta Principles to analyse narratives of violations. A codebook was developed through contextual, manifest and latent coding, with themes, categories and codes converted into quantitative variables for statistical analysis. Descriptive statistics were used to identify the characteristics of violations. RESULTS: A total of 456 cases of rights violations related to SOGI and HIV were documented, ranging from 22 cases in Tajikistan to 217 in Ukraine. Most violations concerned gbMSM (76.5%), with one-fifth involving TP, predominantly transgender women. Complex violations with multiple perpetrators or infringements were documented in Armenia and central Asia. Privacy rights were commonly violated, often through outing. Cases of violations of the right to the highest attainable standard of health (13.6%) and protection from medical abuses (2.6%) were also documented. Other rights violations were sporadic, with each country exhibiting distinct patterns of violated rights and types of violations. In Ukraine, the full-scale war in 2022 influenced the nature of documented cases, reflecting the challenges faced by gbMSM and TP. CONCLUSIONS: Monitoring rights violations proved effective for assessing the situation of gbMSM and TP, particularly in the insufficiently studied and diverse eastern Europe, Caucasus and central Asia regions. As rights violations are linked to both legislation and law enforcement practices, comprehensive interventions to minimize structural and interpersonal stigma are essential.

A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020.

BACKGROUND: Isoniazid (INH, H) resistance is the most common drug-resistant TB pattern, with treatment success rates lower than those in drug-susceptible TB. The WHO recommends a 6-month regimen of rifampicin (RIF, R), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (Lfx) (6REZLfx) for INH-resistant, RIF-susceptible TB (HRRS-TB). Uzbekistan has a high burden of TB (62/100,000 population) and multidrug-resistant TB (12/100,000 population). METHODS: We conducted a retrospective, descriptive study of microbiologically confirmed HRRS-TB using routinely collected programmatic data from 2009 to 2020. RESULTS: We included 854 HRRS-TB cases. Treatment success was 80.2% overall. For REZLfx, the treatment success rate was 92.0% over a short treatment duration, with no amplifications to RIF or second-line anti-TB drug resistance. We documented 46 regimens with REZLfx plus linezolid (success 87.0%) and 539 regimens using kanamycin or capreomycin (success 76.6%). We identified 37 treatment failures (4.3%), 30 deaths (3.5%), 25 resistance amplifications (2.9%), including eight to RIF (0.9%), and 99 lost to follow-up (LTFU) cases (11.6%). Unsuccessful outcomes were more common with older age, diabetes, chest X-ray cavities, smear positivity, smear-positive persistence, and male sex. LTFU was more common with injection-containing regimens. CONCLUSIONS: REZLfx is a safe and effective first-line treatment for INH-resistant, RIF-susceptible TB. Treatment success was lower and LTFU was higher for injection-containing regimens.

CONTEXTE: La résistance à l'isoniazide (INH, H) est la forme de TB pharmacorésistante la plus courante, avec des taux de réussite thérapeutique inférieurs à ceux de la TB pharmacosensible. L'OMS recommande un traitement de six mois à base de rifampicine (RIF, R), d'éthambutol (EMB, E), de pyrazinamide (PZA, Z) et de lévofloxacine (LFx) (6REZLfx) pour la TB résistante à l'INH et sensible au RIF (HRRS-TB). En Ouzbékistan, la prévalence de la TB est élevée, avec un taux de 62 cas pour 100 000 habitants, ainsi que de la TB multirésistante, avec un taux de 12 cas pour 100 000 habitants. MÉTHODES: Une étude rétrospective et descriptive de la HRRS-TB confirmée microbiologiquement a été réalisée en utilisant des données programmatiques collectées de manière routinière de 2009 à 2020. RÉSULTATS: Nous avons inclus 854 cas de HRRS-TB. Le taux de réussite du traitement global était de 80,2%. Pour le traitement avec REZLfx, le taux de réussite était de 92,0% sur une courte durée, sans résistance au RIF ni aux médicaments antituberculeux de deuxième ligne. Nous avons observé 46 schémas thérapeutiques associant REZLfx et linézolide avec un taux de réussite de 87,0%, ainsi que 539 schémas thérapeutiques utilisant la kanamycine ou la capréomycine avec un taux de réussite de 76,6 %. Nous avons enregistré 37 échecs thérapeutiques (4,3%), 30 décès (3,5%), 25 cas de résistance amplifiée (2,9%), dont huit au RIF (0,9%), et 99 cas de perte de suivi (LTFU, pour l'anglais « loss to follow-up ¼) (11,6%). Les échecs étaient plus fréquents chez les patients âgés, diabétiques, présentant des cavités à la radiographie thoracique, un frottis positif persistant et de sexe masculin. La prolongation de la durée d'utilisation était plus fréquente avec les schémas contenant des injections. CONCLUSIONS: REZLfx est un traitement de première intention sûr et efficace contre la TB résistante à l'INH et sensible aux RIF. Le succès du traitement était plus faible et le nombre de LTFU était plus élevé pour les schémas contenant des injections.

The Impact of Human Cystic Echinococcosis in the Central Asian Region, 1990-2019.

Objective: This research aims to update knowledge on the regional and national sickness burden attributable to cystic echinococcosis (CE) from 1990 to 2019, as well as epidemiology and disease control, with a particular emphasis on the People's Central Asian Regions. Methods: We calculated the morbidity, mortality, and disability-adjusted life years at the global, regional, and national levels for CE in all central Asian countries from 1990 to 2019, and we analyzed the association between GDP per capita and the disease burden of CE. Results: In 2019, the three greatest numbers of CE cases were recorded in Kazakhstan [23986; 95% uncertainty interval (UI); 19796; 28908]; Uzbekistan (41079; 18351; 76048); and Tajikistan (10887; 4891; 20170) among all 9 countries. The three countries with the greatest ASIR of CE were estimated to be Kazakhstan (127.56; 95% UI: 105.34-153.8), Uzbekistan (123.53; 95% UI: 58.65-219.16), and Tajikistan (121.88; 58.57-213.93). Kyrgyzstan, Tajikistan, and Uzbekistan had the biggest increases (125%, 97%, and 83%, respectively) in the number of incident cases of CE, whereas Georgia, Kazakhstan, and Armenia saw the largest decreases (45%, 8%, and 3%, respectively). Conclusion: To reduce the illness burden caused by CE, our findings may help public health professionals and policymakers design cost-benefit initiatives. To lessen the impact of CE on society, it is suggested that more money be given to the region's most endemic nations. Echinococcosis, cystic, negative health effects, life-years lost due to disability, rate of occurrence as a function of age, rate of death as a function of age.

Progress in Early Detection of HIV in Tajikistan.

HIV early detection (CD4 counts ≥350 cells/µL) is correlated with higher life expectancy among people living with HIV (PLHIV). Several factors, including physical, cultural, structural, and financial barriers, may limit early detection of HIV. This is a first-of-its-kind study on population-level differences in early detection of HIV across time within Tajikistan and any country in the Central Asia region. Utilizing the Tajikistan Ministry of Health's national HIV data (N = 10,700) spanning 2010 to 2023, we developed median regression models with the median CD4 cell count as the outcome and with the following predictors: time (years), region, age, gender, and area (urban/rural status). Individuals younger than 19 years old were detected early for HIV, whereas those older than 39 years were detected late. Females were detected earlier compared to their male counterparts regardless of region of residence. Rural populations were detected earlier in most years compared to their urban counterparts. The COVID-19 pandemic accelerated HIV early detection in 2021 but most regions have returned to near pre-pandemic levels of detection in 2022 and 2023. There were differences identified among different demographic and geographic groups which warrant further attention.

Scaling Up HIV Self-Testing and Linkage to Care Among Women Who Exchange Sex and/or Use Drugs in Kazakhstan.

HIV testing is the point of entry for linkage to treatment and prevention and is critically important to ending the HIV epidemic. HIV self-testing (HST) is an acceptable, user-controlled tool that can address testing barriers, which is especially important for populations who need to test frequently, like women who exchange or trade sex for money or other needed resources (WES) and women who use drugs. HST is feasible and acceptable among WES, but research among WES who also use drugs is limited, particularly in places like Kazakhstan, where HIV rates remain high and where scale-up of HST and pre-exposure prophylaxis (PrEP) is in process. To develop effective programming, there is a need to develop tailored services for WES and/or use drugs that address key barriers. We discuss opportunities to increase HST and linkage to services among WES and/or use drugs in Kazakhstan, with a focus on stigma reduction.

Molecular Genotyping Analysis Suggested High Clonality and Simple Marker Loci in Puccinia striiformis f. sp. tritici Population in Uzbekistan, Central Asian Region.

Puccinia striiformis f. sp. tritici (Pst) is a destructive pathogen that causes wheat stripe rust worldwide. Understanding the population structure and dynamic of pathogen spread is critical to fight against this disease. Limited information is available for the population genetic structure of Pst in Uzbekistan, Central Asia. In this study, we carried out surveillance from nine different regions (Andijan, Fergana, Jizzakh, Kashkadarya, Namangan, Samarkand, Sirdaryo, Surkhandarya, and Tashkent) of Uzbekistan to fill this gap. A total of 255 isolates were collected, which were genotyped using 17 polymorphic simple sequence repeat markers. The DAPC analysis results showed no population subdivision in these sample-collected regions except Surkhandarya. Multilocus genotype (MLG) analysis, FST, and Nei's genetic distance results indicated a clonal population (rBarD ≤ 0.12) and merely three MLGs accounting for 70% of the overall population. MLG-34 was predominant in all regions of Uzbekistan, followed by MLG-36 and MLG-42. Low genotypic diversity was observed in Andijan, Fergana, Jizzakh, Kashkadarya, Namangan, Sirdaryo, and Tashkent (0.56 to 0.76), compared with Samarkand (0.82) and Surkhandarya (0.97). No virulence against Yr5, Yr15, YrSp, and Yr26 was found, while resistance was overcome against Yr1, Yr2, Yr6, Yr9, Yr17, and Yr44 genes (virulence frequency ≥75%). Comparative study results of Uzbekistan with the previous Himalayan population showed divergence from China and Pakistan populations. Further studies need to be conducted in a worldwide context to understand migration patterns; for that purpose, collaborative work is essential because of the Pst long-distance migration capability.

Factors associated with maternal mortality in Kazakhstan: a pre- and during-pandemic comparison.

Introduction: The maternal mortality indicator serves as a crucial reflection of a nation's overall healthcare, economic, and social standing. It is necessary to identify the variations in its impacts across diverse populations, especially those at higher risk, to effectively reduce maternal mortality and enhance maternal health. The global healthcare landscape has been significantly reshaped by the COVID-19 pandemic, pressing disparities and stalling progress toward achieving Sustainable Development Goals, particularly in maternal mortality reduction. Methods: This study investigates the determinants of maternal mortality in Kazakhstan from 2019 to 2020 and maternal mortality trends in 17 regions from 2000 to 2020, employing data extracted from national statistical reports. Stepwise linear regression analysis is utilized to explore trends in maternal mortality ratios in relation to socioeconomic factors and healthcare service indicators. Results: The national maternal mortality ratio in Kazakhstan nearly tripled from 13.7 in 2019 to 36.5 per 100,000 live births in 2020. A remarkable decrease was observed from 2000 until around 2015 with rates spiked by 2020. Significant factors associated with maternal mortality include antenatal care coverage and the number of primary healthcare units. Additionally, socioeconomic factors such as secondary education enrollment and cases of domestic violence against women emerged as predictors of MMR. Moreover, the impact of the pandemic was evident in the shift of coefficients for certain predictors, such as antenatal care coverage in our case. In 2020, predictors of MMR continued to include secondary education enrollment and reported cases of domestic violence. Conclusion: Despite Kazakhstan's efforts and commitment toward achieving Sustainable Development Goals, particularly in maternal mortality reduction, the impact of the COVID-19 pandemic poses alarming challenges. Addressing these challenges and strengthening efforts to mitigate maternal mortality remains imperative for advancing maternal health outcomes in Kazakhstan.

Exposure assessment of dairy cows to parabens using hair samples analysis.

Parabens (PBs) are used as preservatives in various products. They pollute the environment and penetrate living organisms, showing endocrine disrupting activity. Till now studies on long-term exposure of farm animals to PBs have not been performed. Among matrices using in PBs biomonitoring hair samples are becoming more and more important. During this study concentration levels of methyl paraben (MeP), ethyl paraben (EtP), propyl paraben (PrP) butyl paraben (BuP) and benzyl paraben (BeP) were evaluated using liquid chromatography-mass spectrometry (LC-MS) in hair samples collected from dairy cows bred in the Kyrgyz Republic. MeP was noted in 93.8% of samples (with mean concentration levels 62.2 ± 61.8 pg/mg), PrP in 16.7% of samples (12.4 ± 6.5 pg/mg) and EtP in 8.3% of samples (21.4 ± 11.9 pg/mg). BuP was found only in one sample (2.1%) and BeP was not detected in any sample included in the study. Some differences in MeP concentration levels in the hair samples depending on district, where cows were bred were noted. This study has shown that among PBs, dairy cows are exposed mainly to MeP, and hair samples may be a suitable matrix for research on PBs levels in farm animals.

Air quality challenges in Central Asian urban areas: a PM2.5 source apportionment analysis in Dushanbe, Tajikistan.

This work presents the first comprehensive assessment of PM pollution sources in Dushanbe, Tajikistan. A total of 138 PM2.5 samples were collected during 2015-2016 and 2018-2019 and were analyzed through gravimetric, ED-XRF, and multi-wavelength absorption techniques. The results show that PM2.5 concentrations were substantially higher than the European annual limit value and WHO Air Quality Guidelines annual average value, with an average of 90.9 ± 68.5 µg m-3. The PMF application identified eight sources of pollution that influenced PM2.5 concentration levels in the area. Coal burning (21.3%) and biomass burning (22.3%) were the dominant sources during the winter, while vehicular traffic (7.7%) contributed more during the warm season. Power plant emissions (17.5%) showed enhanced contributions during the warm months, likely due to high energy demand. Cement industry emissions (6.9%) exhibited significant contribution during the cold period of 2018-2019, while soil dust (11.3%) and secondary sulphates (11.5%) displayed increased contribution during the warm and cold months, respectively. Finally, waste burning (1.5%) displayed the lowest contribution, with no significant temporal variation. Our results highlight the significant impact of anthropogenic activities, and especially the use of coal burning for energy production (both in power plants and for residential heating), and the significant contribution of biomass burning during both warm and cold seasons.