Antimicrobial resistance and molecular epidemiological typing of Neisseria gonorrhoeae isolates from Kyrgyzstan in Central Asia, 2012 and 2017.

BACKGROUND: Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are significant public health concerns globally. Nearly no gonococcal AMR data are available from Central Asia, and no data from Kyrgyzstan has been published. We examined, for the first time, AMR and molecular epidemiology of N. gonorrhoeae isolates cultured in Kyrgyzstan in 2012 and 2017, in order to inform refinements of the Kyrgyz national gonorrhoea management guidelines. METHODS: N. gonorrhoeae isolates cultured in 2012 (n = 84) and 2017 (n = 72) in Kyrgyzstan were examined. MICs of nine antimicrobials were determined using Etest and, where available, clinical breakpoints from the EUCAST were applied. N. gonorrhoeae multiantigen sequence typing (NG-MAST) was also performed. RESULTS: The overall resistance levels were high to ciprofloxacin (88.5%), tetracycline (56.9%), benzylpenicillin (39.1%), and kanamycin (4.7%). Resistance to cefixime (0.6%, n = 1 isolate), azithromycin (0.6%, n = 1), and gentamicin (0.6%, n = 1) was rare. No resistance to ceftriaxone or spectinomycin was found. However, the proportion of isolates with decreased susceptibility (MIC = 0.125 mg/L) to ceftriaxone and cefixime was 12.8 and 11.5%, respectively. Gonococcal isolates were assigned 69 sequence types, of which 52 (75.4%) were new. CONCLUSIONS: The gonococcal population in Kyrgyzstan in 2012 and 2017 showed a high genetic diversity. Ceftriaxone, 500-1000 mg, in combination with azithromycin 2 g or doxycycline, particularly when chlamydial infection has not been excluded, should be recommended as empiric first-line treatment. Spectinomycin 2 g could be an alternative treatment, and given with azithromycin 2 g if pharyngeal gonorrhoea has not been excluded. Fluoroquinolones, aminoglycosides, benzylpenicillin, or tetracyclines should not be used for empiric treatment of gonorrhoea in Kyrgyzstan. Timely updating and high compliance to national gonorrhoea treatment guidelines based on quality-assured AMR data is imperative. Expanded and improved gonococcal AMR surveillance in Kyrgyzstan is crucial.

Trans fatty acid elimination policy in member states of the Eurasian Economic Union: Implementation challenges and capacity for enforcement.

Removing trans fatty acids (TFAs) from the food supply in the Eurasian Economic Union (EAEU) are one of the most effective public health interventions for reducing the risk of noncommunicable diseases. EAEU Member States have taken important steps to reduce TFA in oil and fat products to <2% of the total fat content. The authors summarize existing policies in the region, identify challenges in implementation, and suggest measures to strengthen regulation to achieve compliance with WHO guidelines. Documents published between 2011 and 2019 in Russian and English were reviewed, including EAEU and Member State restrictions on TFA in food products, data on TFA content in foods, and food labeling policies. The EAEU has established TFA limits in oil and fat products; however, Member States are currently not achieving the WHO guideline of <2% of total fat content in food products. A lack of harmonized monitoring systems and sanctions create challenges in monitoring compliance. The authors recommend developing an EAEU-wide monitoring system to test TFA content and organize population intake surveys. Discrepancies exist within regulatory frameworks that allow higher levels of TFAs in dairy products and infant formula. The authors recommend extending the current regulation to mandate TFA limits for all food products. Research found that strengthening regulation to meet the WHO guidelines should be prioritized. Member States should implement actions to replace TFAs with healthier fats, develop standardized surveillance methods, and scale-up strategic communication to ensure the food industry and the public follow public health recommendations to protect the health of the EAEU population.

Evaluation of opioid substitution therapy in Kyrgyzstan

An evaluation of the opioid substitution therapy (OST) programme in Kyrgyzstan took place from 15 to 19 June 2015.This evaluation was a follow up of the previous one by a World Health Organization (WHO) mission in 2008. A delegation from the WHO Regional Office for Europe met with representatives of the Government, Drug Control Agency, Ministry of Health, Ministry of Justice, United Nations agencies, international nongovernmental organizations (NGOs), staff of drug treatment services and NGOs. Mission members conducted focus group discussions and one-on-one interviews with injecting drug users at several OST sites. This evaluation explored how the country had implemented the recommendations from the earlier evaluation in 2008.The WHO mission developed further recommendations on the sustainability of OST, how to increase its accessibility, and improve its quality in the civil and penitentiary sectors.

Оценка эффективности опиоидной заместительной терапии в местах лишения свободы: предварительное исследование в Кыргызстане

В 2009-2010 гг. была проведена оценка результатов экспериментальной программы опиоиднойзаместительной терапии в исправительном учреждении – колонии № 47 в г. Бишкеке (Кыргызстан). В ходеисследования с целью оценки результатов программы на курс метадоновой поддерживающей терапии былопринято восемьдесят четыре пациента. Оценка состояния пациентов проводилась до начала курса и через 3 и6 месяцев после начала. Использовались принятые ВОЗ инструменты исследования, переведенные нарусский язык и применявшиеся в предыдущих исследованиях по изучению исходов опиоиднойзаместительной терапии. Они включали индекс лечения опиоидной зависимости, вопросник ВОЗ для оценкикачества жизни WHOQOL-BREF, вопросник для оценки риска передачи гемотрансмиссивных вирусов, шкалуЗанга для самооценки депрессии и другие. Результаты исследования показывают систематическое улучшениесостояния здоровья и качества жизни у пациентов, получающих опиоидную заместительную терапию, а такжезначительное снижение рискованных форм поведения при инъекционном потреблении наркотиков,связанных с передачей ВИЧ-инфекции и других гемотрансмиссивных вирусов.

Evaluation of opioid substitution therapy in prisons: pilot study in Kyrgyzstan

The evaluation of the outcome of the pilot Opioid Substitution Therapy programme in Penitentiary Institution No. 47 in Bishkek (Kyrgyzstan) took place in 2009–2010. The programme’s participants consisted of 84 patients enrolled in methadone maintenance therapy. Assessments were carried out at baseline and after 3 and 6 months. Instruments adopted by WHO, translated into Russian and applied in earlier opioid substitution therapy outcome studies, were used. They included the Opiate Treatment Index, the World Health Organization Quality of Life–BREF questionnaire, the Bloodborne Virus Transmission Risk Assessment Questionnaire, the Zung Self-Rating Depression Scale and others. Results of the study indicate the consistent improvement of health and quality of life among opioid substitution therapy patients, as well as the significant reduction of injecting risk behaviour in relation to transmission of HIV and other bloodborne viruses.