Household drug-resistant TB contact tracing in Tajikistan.

BACKGROUND: Tajikistan has a high burden of rifampicin-resistant TB (RR-TB), with 2,700 new cases estimated for 2021 (28/100,000 population). TB is spread among household members through close interaction and children exposed through household contact progress to disease rapidly and frequently.METHODS: We retrospectively analysed programmatic data from household contact tracing in Dushanbe over 50 months. We calculated person-years of follow-up, contact tracing yield, number needed to screen (NNS) and number needed to test (NNT) to find one new case, and time to diagnosis.RESULTS: We screened 6,654 household contacts of 830 RR-TB index cases; 47 new RR-TB cases were detected, 43 in Year 1 and 4 in Years 2 or 3. Ten were aged <5 years; 46/47 had TB symptoms, 34/45 had chest radiographs consistent with TB, 11/35 were Xpert Ultra-positive, 29/32 were tuberculin skin test-positive and 28/47 had positive TB culture and phenotypic drug susceptibility results. The NNS to find one RR-TB case was 141.57 and the NNT was 34.49. The yields for different types of contacts were as follows: 0.7% for screened contacts, 2.9% for tested contacts, 17.0% for symptomatic contacts and 12.1% for symptomatic contacts aged below 5 years.CONCLUSION: RR-TB household contact tracing was feasible and productive in Tajikistan, a low middle-income country with an inefficient healthcare delivery system.

Assessment of serological responses following vaccination campaigns with type 2 novel oral polio vaccine: a population-based study in Tajikistan in 2021.

BACKGROUND: Novel oral poliovirus vaccine type 2 (nOPV2) was used to control an outbreak of type 2 circulating vaccine derived poliovirus (cVDPV2) in Tajikistan, in 2021. We measured seroconversion and seroprevalence of type 2 polio antibodies in children who were reported to have received two doses of nOPV2 in outbreak response campaigns. METHODS: In this community serosurvey, children born after Jan 1, 2016 were enrolled from seven districts in Tajikistan. Dried blood spot cards were collected before nOPV2 campaigns and after the first and second rounds of the campaigns and were sent to the Centers for Disease Control and Prevention (Atlanta, GA, USA) for microneutralisation assay to determine presence of polio antibodies. The primary endpoint was to assess change in seroprevalence and seroconversion against poliovirus serotype 2 after one and two doses of nOPV2. FINDINGS: 228 (97%) of 236 enrolled children were included in the analysis. The type 2 antibody seroprevalence was 26% (53/204; 95% CI 20 to 33) before nOPV2, 77% (161/210; 70 to 82) after one dose of nOPV2, and 83% (174/209; 77 to 88) after two doses of nOPV2. The increase in seroprevalence was statistically significant between baseline and after one nOPV2 dose (51 percentage points [42 to 59], p<0·0001), but not between the first and second doses (6 percentage points [-2 to 15], p=0·12). Seroconversion from the first nOPV2 dose, 67% (89/132; 59 to 75), was significantly greater than that from the second nOPV2 dose, 44% (20/45; 30 to 60; χ2 p=0·010). Total seroconversion after two nOPV2 doses was 77% (101/132; 68 to 83). INTERPRETATION: Our study demonstrated strong immune responses following nOPV2 outbreak response campaigns in Tajikistan. Our results support previous clinical trial data on the generation of poliovirus type 2 immunity by nOPV2 and provide evidence that nOPV2 can be appropriate for the cVDPV2 outbreak response. The licensure and WHO prequalification of nOPV2 should be accelerated to facilitate wider use of the vaccine. FUNDING: World Health Organization, Centers for Disease Control and Prevention, and Rotary International.

Screening for Gestational Diabetes Mellitus and Pregnancy Outcomes: Results from a Multicentric Study in Tajikistan.

The prevalence of gestational diabetes parallels the prevalence of type 2 diabetes mellitus and is associated with adverse pregnancy outcomes. However, these data are not available for many parts of the world. We assessed the prevalence of gestational diabetes and pregnancy outcomes in Tajikistan. This cohort study included 2438 consecutively recruited representative pregnant women from 8 locations in two cities in Tajikistan, in whom an oral glucose tolerance test (75 g, fasting, 1 h, 2 h) was performed during gestational weeks 24-28. Women with known diabetes and twin pregnancies were excluded. Associations between glucose tolerance test results and pregnancy outcomes were examined. According to the WHO 2013 thresholds, 32.4% of women qualified as having gestational diabetes, the vast majority (29.7%) based on an elevated fasting glucose level (5.1-5.6 mmol/L), while only 2.8% had elevated 1- or 2-hour values or met more than one threshold. Women with only elevated fasting glucose (impaired gestational fasting glycemia) had no evidence of adverse pregnancy outcomes, while those with elevated 1- and/or 2-hour values (impaired gestational glucose tolerance) had more pregnancy complications (infection of urinary tract 1.8 vs. 8.8% p<0.001; preeclampsia 0.7 vs. 10.3% p<0.001) and emergency cesarean sections (4.4 vs. 13.2% p=0.002). Neonates from pregnancies with impaired gestational glucose tolerance had lower APGARs, lower birth weights, lower 30 min glucose levels, and a lower probability of being discharged alive (all p<0.05). In conclusion, the formal prevalence of gestational diabetes is high in Tajikistan; however, this does not translate into adverse pregnancy outcomes for women with impaired gestational fasting glycemia.

Demographic and environmental factors associated with disability in India, Laos, and Tajikistan: a population-based cross-sectional study.

BACKGROUND: The number of people experiencing functional limitations due to health conditions (capacity) is expected to increase in low and middle-income countries as populations age and rates of non-communicable disease rise. This trend could raise the prevalence and levels of disability worldwide. Understanding the demographic and environmental factors associated with disability can inform the design of policy interventions to make societies more accessible and inclusive for all. METHODS: Approximately 2,500-3,000 participants in each of India, Laos, and Tajikistan responded to the Gallup World Poll and the World Health Organization's Brief Model Disability Survey through face-to-face interviews. For each country, random forest regression was performed to explore the associations of demographic and environmental factors with disability while controlling for capacity. Using the variable importance measures generated by the random forest models, linear regression models were built in a stepwise manner for each country to predict disability level based on these contextual factors. RESULTS: Capacity was strongly associated with disability in all three countries. Most of the variance in disability was explained by minimally adjusted linear models that included only capacity, sex, and age. Inclusion of additional demographic factors and environmental factors explained slightly more of the variance in disability score. Across all three countries, the level of basic infrastructure, public services, and financial stability were moderately associated with disability. Age, sex, employment status, the use of assistive technologies, and other factors had associations with disability that were highly variable across countries. CONCLUSION: While capacity was the main determinant of disability, individual demographic and environmental factors were associated with disability in a country-specific manner while controlling for the effects of capacity.

Resilience against the pandemic: The impact of COVID-19 on migration and household welfare in Tajikistan.

The COVID-19 pandemic is likely to have adverse effects on the economy through damage to migration and remittances. We use a unique monthly household panel dataset that covers the period both before and after the outbreak to examine the impacts of COVID-19 on a variety of household welfare outcomes in Tajikistan, where remittance inflows in recent years have exceeded a quarter of annual GDP. We provide several findings. First, after April 2020, the adverse effects of the pandemic on household welfare were significantly observed and were particularly pronounced in the second quarter of 2020. Second, in contrast to expectation, the pandemic had a sharp but only transitory effect on the stock of migrants working abroad in the spring. Some expected migrants were forced to remain in their home country during the border closures, while some incumbent migrants expecting to return were unable to do so and remained employed in their destination countries. Both departures and returns started to increase again from summer. Employment and remittances of the migrants quickly recovered to levels seen in previous years after a sharp decline in April and May. Third, regression analyses reveal that both migration and remittances have helped to mitigate the adverse economic outcomes at home during the "with-COVID-19" period, suggesting that they served as a form of insurance. Overall, the unfavorable effects of the COVID-19 pandemic were severe and temporary right after the outbreak, but households with migrants were more resilient against the pandemic.

Evaluation and pilot implementation of essential interventions for the management of hypertension and prevention of cardiovascular diseases in primary health care in the Republic of Tajikistan.

BACKGROUND: The aim of this study was to determine the feasibility of implementing and evaluating essential interventions for the management of hypertension and prevention of cardiovascular disease in primary healthcare in Tajikistan. METHODS: The study protocol was published a priori. A pragmatic, sequential, mixed methods explanatory design was piloted. The quantitative strand is reported here. All primary health care facilities that met inclusion criteria in Shahrinav district were included and computer randomized to either usual care or intervention. The intervention consisted of: adaptation of WHO PEN/HEARTS clinical algorithms for hypertension and diabetes, a two-day training of doctors and nurses, supportive supervision visits, clinical decision support tools, and quality improvement support. Data were collected from paper-based clinical records at baseline and 12 months follow-up. The primary outcome was blood pressure control among patients with hypertension, in addition to several secondary process indicators along the care pathway. Age and sex adjusted logistic regression models were used for intervention and control clinics to determine changes between baseline and follow-up and to assess interactions between allocation group and time. For continuous variables, multivariate linear regression models were used. RESULTS: 19 primary health care centres were included of which ten were randomized to intervention and nine to control. 120 clinicians received training. The records of all registered hypertensive patients were reviewed at baseline and follow-up for a total of 1,085 patient records. Blood pressure control significantly improved in the intervention clinics (OR 3.556, 95 % CI 2.219, 5.696) but not the control clinics (OR 0.644, 95 % CI 0.370, 1.121) (p < 0.001 for interaction). Smoking assessment, statin prescribing, triple therapy prescribing, and blood pressure measurement significantly improved in intervention clinics relative to control, whereas cholesterol and glucose testing, and aspirin prescribing did not. CONCLUSIONS: It is feasible to use routine, paper-based, clinical records to evaluate essential CVD interventions in primary health care in Tajikistan. Adapted WHO PEN/HEARTS guidelines in the context of a complex intervention significantly improved blood pressure control after 12 months.

HIV and associated factors among female sex workers in Tajikistan: Analysis from a national bio-behavioral survey.

Tajikistan, a country of approximately nine million people, has a relatively small but quickly growing HIV epidemic. No peer-reviewed study has assessed factors associated with HIV, or associated risk factors, among female sex workers (FSWs) in Tajikistan. The purpose of the current study is to elucidate the factors associated with HIV status and risk factors in the Tajikistani context and add to the scant literature on risk factors among FSWs in Tajikistan and Central Asia. We used cross-sectional data from an HIV bio-behavioral survey (BBS) conducted among FSWs in the Republic of Tajikistan (n = 2174) in 2017. Using Respondent Driven Sampling Analysis Tool software, we calculated the prevalence of HIV, diagnosed cases, linkage to antiretroviral therapy (ART), and the prevalence of syphilis for FSWs in Tajikistan. Prevalence data were adjusted for network size and any clustering effects in the network. Further, using univariate and multivariable logistic regression, we determined correlates of HIV-positive status. Results were as follows: Of all FSWs in Tajikistan, 2.6% (95% CI: 1.7-3.8%) are HIV positive, 2.3% (95% CI: 1.4-3.5%) are diagnosed and aware of their status, and 2.0% (95% CI: 1.2-3.1%) are on ART. About 5.7% (95% CI: 4.5-7.4%) of FSWs in Tajikistan have ever had syphilis, and 0.8% (95% CI: 0.4-1.3%) have active syphilis infections. The epidemic of injection drug use was found to be strongly synergistic with HIV infection as having had sex with a person who injects drugs was shown to be strongly associated with HIV-positive status (OR: 5.2; 95% CI: 2.6-10.2) in the multivariable model. While this study estimates that HIV prevalence among Tajikistani FSWs is relatively low, it is likely an underestimated due to selection and social desirability biases. To curb the small, but potentially volatile, HIV epidemic among FSWs, the government should consider targeted testing and linkage-to-care efforts for FSWs who inject drugs or who have people who inject drugs partners. Services should also be prioritized in Gorno-Badakhshan, which has a higher number of FSWs per capita relative to other regions. Additionally, the link between HIV and experiences of stigma, violence, and discrimination against FSWs should motivate advocates to protect Tajikistani FSWs from these experiences.

Genetic analysis of genotype G57 H9N2 avian influenza virus isolate A/chicken/Tajikistan/2379/2018 recovered in Central Asia.

This paper presents genetic data on the full genome analysis of A/chicken/Tajikistan/2379/2018 H9N2 influenza virus isolated in September 2018 from chicken pathological material received from poultry farms of the Republic of Tajikistan and subtyped as H9N2 by serological and molecular methods. According to the results of hemagglutinin gene sequencing, the amino acid sequence of the cleavage site was RSSR/GLF, which is typical for low-virulent avian influenza virus. Phylogenetic analysis of the nucleotide sequence of a hemagglutinin gene fragment (nt 1-1539 of the open reading frame) showed that the A/chicken/Tajikistan/2379/2018 H9N2 isolate belongs to the Y280 genetic group of low-virulent A/H9 influenza virus, which is widespread in Southeast Asia. The complete nucleotide sequence of the viral genome was determined. Comparative analysis of all genomic segments revealed that the A/chicken/Tajikistan/2379/2018 H9N2 virus is closely related to an A/H9 influenza virus isolated in the Far East of the Russian Federation in 2018. Genetic similarity (97.1-99% identity in four out of eight viral genes) was found to isolates of an H7N9 subtype virus recovered in the Inner Mongolia and Hebei regions of China in 2017. According to the analysis of the predicted amino acid sequence of the studied isolate, the positions of some molecular markers indicate possible adaptation of the virus to mammals. Further genetic analysis showed that this virus belongs to genotype G57.

Volunteer Community Health and Agriculture Workers Help Reduce Childhood Malnutrition in Tajikistan.

Childhood malnutrition is a nationally-recognized problem in Tajikistan. In 2017, 6% of children under 5 years were wasted and 18% were stunted. Through the Tajikistan Health and Nutrition Activity (THNA), funded by the U.S. Agency for International Development's Feed the Future, IntraHealth International trained 1,370 volunteer community health workers (CHWs) and 500 community agricultural workers (CAWs) in 500 rural communities to improve nutrition among children and pregnant and breastfeeding women. CHWs and CAWs mutually encourage health behavior change, reinforce better agricultural practices, and promote maternal and child health and nutritious diets through household visits, community events, and peer support groups. CHWs refer children with malnutrition and diarrhea and pregnant women who are not registered for antenatal care to health facilities. THNA supported CHWs/CAWs through peer learning, refresher trainings, supportive supervision, and quarterly material incentives. We observed gains in knowledge, attitudes, and practices across health; nutrition; water, sanitation, and hygiene (WASH); and agriculture in target communities. From 2016 to 2019, we observed statistically significant (P<.05) improvements in children receiving a minimum acceptable diet; children with diarrhea receiving more liquids; women making 4 or more antenatal care visits; women reporting improved WASH; and farmers demonstrating improved agricultural practices. A February 2020 screening of 94.6% of children under 5 years in target communities found the prevalence of children with signs of wasting at 2.2%. Partnerships between CHWs, CAWs, and rural health workers facilitated these results. Paired agricultural and health interventions proved successful in improving nutrition of children and may be applicable in other contexts. Although effective in delivering interventions, CHWs/CAWs experience attrition, need motivation, and require intensive support. Assuming responsibility for this community-based volunteer workforce presents a major challenge for Tajikistan's national and local governments.

Parts Unknown: Risk Factors of Intimate Partner Violence in Azerbaijan, Kyrgyzstan, Tajikistan, and Moldova.

Extant research has argued that there are variations in predictors of intimate partner violence (IPV) across nations and it is necessary to examine country-specific correlates of IPV. Much remains unknown about factors that affect risk of IPV in transitional countries. Specifically, we explore risk factors for IPV among four former nations of the Soviet Union-Azerbaijan, Kyrgyzstan, Tajikistan, and Moldova-with data from the nationally representative Demographic and Health Surveys. Rates of physical abuse were similar within Tajikistan (18.96%) and Moldova (18.38%), while Kyrgyzstan (20.62%) had the highest prevalence and Azerbaijan (9.29%) had the lowest prevalence. In contrast, the prevalence of sexual abuse was very similar across the four countries and was much lower (between 1.00% and 3.50%) than cross-national estimates of physical abuse. Findings suggest that many of the same risk factors of IPV in developing and developed nations influence risk of IPV in transitional nations. Across the four former Soviet nations included in analyses, the experience of controlling behaviors, husband's alcohol use, and witnessing IPV or experiencing abuse during childhood were all significantly associated with risk of physical and sexual abuse later in life. Indeed, the intergenerational transmission of violence may be a cross-national phenomenon. In addition, equality in decision making did not have an effect on risk of physical and sexual violence, except for risk of physical abuse in Moldova. This may be due to the historical context of these nations. Taken together, findings suggest that country context may influence individual risk factors of IPV.

Tuberculosis in key populations in Tajikistan - a snapshot in 2017.

INTRODUCTION: WHO End TB Strategy aims at achieving targets of 90% mortality reduction and 80% reduction in tuberculosis (TB) incidence by 2030, recommending better addressing TB and multidrug-resistant TB (MDR-TB) issues in key populations. AIM: The study aimed at having a snapshot of the epidemiological characteristics of the key populations among the new TB patients, registered in Tajikistan during 2017. METHODOLOGY: A cross-sectional study was conducted, using official TB registration data for all new TB case notification in Tajikistan in 2017. RESULTS: The key population included 1,029 (19.8%) patients among all 5,182 new TB cases registered in 2017. The following selected sub-populations were identified: migrant workers - 728 (70.7%), diabetics - 162 (15.7%), HIV-positive - 138 (13.4%), heavy drinkers - 74 (7.2%), drug users - 50 (4.8%), ex-prisoners - 50 (4.8%), and homeless - 9 (0.9%). Among the key population, 307 (29.8%) patients were smear-positive, 145 (14.1%) were drug-sensitive and 116 (11.3%) had MonoDR/MDR-TB. Time to treatment initiation for smear-positive cases was ≤ 5 days for 303 (98.7%) patients. Being a key population was inversely related to gender (female) (OR = 0.25, 95% CI (0.21, 0.29)) and population type (rural) (OR = 0.64, 95% CI (0.55, 0.74)). CONCLUSION: Among the key population the identified overlaps of selected sub-populations would enable more efficiently reaching the certain groups. TB case detection at PHC levels needs to be targeted for improved rates for key population detection. In the key population sub-group of migrant workers' special migration destinations are recommended to be explored and find out possible associations with drug resistance.

Association between time spent in the Russian Federation and late presentation for HIV among Tajikistani migrants.

BACKGROUND: Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajikistani migrants upon their return to Tajikistan. METHOD: This study uses data from the Tajikistan Ministry of Health surveillance system (2006 - 2019). At time of diagnosis, patients are interviewed by staff of AIDS centers, and doctors complete routine intake forms and complete medical exams. Descriptive characteristics of migrants with HIV who had lived in the Russian Federation (n=503) were calculated and compared with those of non-migrants with HIV (n=9519). Missing data were imputed using multiple imputation (predictive means matching, logistic regression imputation, and polytomous regression imputation). Two logistic models were created to model the probability of late presentation for HIV. The first model shows unadjusted associations between predictor variables and late presentation for HIV. The second model shows multivariable associations between significant study variables identified in the univariate model, and late presentation. RESULTS: Compared to non-migrants, migrants with HIV are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, and are more likely to have purchased the services of sex workers. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for a Tajikistani migrant with HIV increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for a Tajikistani migrant with HIV increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation. CONCLUSION: The results of this paper suggest that if the Russian Federation were to loosen its restrictions on HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. As this analysis is only correlational in nature, further research is needed to explicate the causal pathways of the associations found in the present analysis.

Awareness and knowledge about HIV/AIDS among women of reproductive age in Tajikistan.

Using data from the 2012 and 2017 Tajikistan Demographic and Health Surveys (DHS), this research explores the trends and determinants of HIV/AIDS awareness and knowledge among women of reproductive age in Tajikistan across two time periods and identifies areas for improvement. The results of this research indicate that nearly four in ten women had not heard of HIV/AIDS before participating in the DHS. Moreover, between 2012 and 2017, the level of HIV/AIDS awareness among women decreased from 63% to 57%. Although the level of HIV knowledge increased from 21% in 2012-33% in 2017, many women still lack knowledge about the modes of HIV transmission and effective prevention methods. Considering that the HIV epidemic is currently increasing in Tajikistan, HIV/AIDS prevention interventions are urgently needed that include outreach efforts targeting younger women and those from rural areas and lower socioeconomic groups.

Nutritional status of Tajik children and women: Transition towards a double burden of malnutrition.

The double burden of malnutrition, an emerging concern in developing countries, can exist at various levels: individual, household, and population. Here, we explore the nutritional status of Tajik women (15-49 years) and children (5-59 months) focusing on overweight/obesity along with undernutrition (underweight, stunting, and micronutrient deficiencies). For this, nutritional markers (haemoglobin (Hb), transferrin receptor (TfR), serum ferritin (Sf), retinol binding protein (RBP), vitamin D, serum folate, and urinary iodine), height, and weight were assessed from 2,145 women and 2,149 children. Dietary intake, weaning, and breastfeeding habits were recorded using a 24-hr recall and a questionnaire. Overweight (24.5%) and obesity (13.0%) are increasing among Tajik women compared with previous national surveys (2003 and 2009). Prevalence of iron deficiency and anaemia was 38.0% and 25.8%, respectively; 64.5% of women were iodine deficient, 46.5% vitamin A deficient, and 20.5% had insufficient folate levels. Women in rural areas had significantly lower iron status and body mass index and higher iodine intake compared with urban areas; 20.9% of children were stunted, 2.8% wasted, 6.2% underweight, 52.4% iron deficient, and 25.8% anaemic; all more prominent in rural areas. Dietary diversity was higher among urban women. Intraindividual or household double burden was not seen. In summary, double burden of malnutrition constituted an increase in overweight among women, especially in urban areas, and persisting levels of undernutrition (stunting, iron, and vitamin A deficiency), predominately in rural areas. A holistic, innovative approach is needed to improve infant and young children feeding and advise mothers to maintain an adequate diet.

Population structure of drug-resistant Mycobacterium tuberculosis in Central Asia.

BACKGROUND: Drug-resistant tuberculosis (TB) is a major public health concern threathing the success of TB control efforts, and this is particularily problematic in Central Asia. Here, we present the first analysis of the population structure of Mycobacterium tuberculosis complex isolates in the Central Asian republics Uzbekistan, Tajikistan, and Kyrgyzstan. METHODS: The study set consisted of 607 isolates with 235 from Uzbekistan, 206 from Tajikistan, and 166 from Kyrgyzstan. 24-loci MIRU-VNTR (Mycobacterial Interspersed Repetitive Units - Variable Number of Tandem Repeats) typing and spoligotyping were combined for genotyping. In addition, phenotypic drug suceptibility was performed. RESULTS: The population structure mainly comprises strains of the Beijing lineage (411/607). 349 of the 411 Beijing isolates formed clusters, compared to only 33 of the 196 isolates from other clades. Beijing 94-32 (n = 145) and 100-32 (n = 70) formed the largest clusters. Beijing isolates were more frequently multidrug-resistant, pre-extensively resistant (pre-XDR)- or XDR-TB than other genotypes. CONCLUSIONS: Beijing clusters 94-32 and 100-32 are the dominant MTB genotypes in Central Asia. The relative size of 100-32 compared to previous studies in Kazakhstan and its unequal geographic distribution support the hypothesis of its more recent emergence in Central Asia. The data also demonstrate that clonal spread of resistant TB strains, particularly of the Beijing lineage, is a root of the so far uncontroled MDR-TB epidemic in Central Asia.

Risk factors for unfavourable treatment outcomes among rifampicin-resistant tuberculosis patients in Tajikistan.

SETTING: Tajikistan is among the 30 countries with the highest multidrug-resistant tuberculosis (MDR-TB) burden. OBJECTIVE: To investigate the risk factors for unfavourable treatment outcomes among rifampicin-resistant (RR)/MDR-TB patients. DESIGN: Retrospective medical chart review of RR/MDR-TB patients enrolled for treatment in 2012-2013. RESULTS: Of 601 RR/MDR-TB patients, 58 (9.7%) had pre-extensively drug-resistant TB (pre-XDR-TB; i.e., MDR-TB with additional resistance to a fluoroquinolone or second-line injectable agent) and 45 (8%) had XDR-TB (MDR-TB with additional resistance to both). Treatment failure and death were reported in respectively 40 (7%) and 89 (15%) cases; 60 (10%) patients were lost to follow-up (LTFU). In multivariable analysis, treatment failure was associated with pre-XDR-TB (adjusted odds ratio [aOR] 3.67, 95%CI 1.47-9.18) or XDR-TB (aOR 8.61, 95%CI 3.48-21.34). Death was associated with age >45 years vs. <25 years (aOR 3.47, 95%CI 1.68-7.19) and no record of any adverse event during treatment (aOR 2.55, 95%CI 1.48-4.39). Changing place of residence during treatment was an independent predictor of LTFU (aOR 4.61, 95%CI 2.41-8.8). CONCLUSIONS: Our findings highlight the need for 1) the use of regimens with new anti-tuberculosis drugs; 2) good handover of TB patients and 3) effective tracing mechanisms if patients change a place of residence to prevent LTFU.

Intimate Partner Violence in Tajikistan: Risk and Protective Factors.

Background: Violence against women perpetrated by intimate partners (IPV) is a sufficiently serious social issue in the countries of the former Soviet Union to warrant focused attention and sociological research. In spite of recent advances in the understanding of the prevalence and detrimental consequences of IPV worldwide, little is known about IPV in transitional countries, where very few studies have been carried out. Investigating IPV against women in different societies and analyzing micro- and macro-level factors (i.e., social, economic, psychological, etc.) that contribute to IPV is important for social scientists in order to understand the nature of IPV and to combat it. Objectives: The aims of the study were to examine the prevalence of physical IPV in Tajikistan and discuss the risk factors for IPV in this country of the former Soviet Union. Method: This research is based on the data from the Tajik Demographic and Health Surveys conducted in 2012. SPSS 21.0 and STATA 13 were used for statistical analysis, which involved a multistep process and included a series of statistical methods such as a univariate descriptive analysis of IPV predictor and outcome variables and a multilevel regression model for survey data to estimate the effect of individual- and community-level characteristics and to take into consideration the multilevel nature of IPV. The analyses rely upon binomial and ordered logistic regression models. Results: The results of this study demonstrate that physical IPV is not a rare phenomenon in Tajikistan where 18% of women in this region have experienced IPV at some point of their lives, and the rate of lifetime occurrence of IPV is 17.5%. While women's older age and living in rural area are protective factors against IPV in Tajikistan, risk factors for physical IPV include higher number of children, household wealth, women's employment, partner's alcohol consumptions, witnessing IPV in women's family of origin, justification of IPV by women, and partner's controlling behavior. Conclusion: The current study provides evidence that a significant number of women are physically abused by their intimate partners in Tajikistan. In the context of the significant structural changes and the strengthening of patriarchal ideology resulted by the collapse if the Soviet Union, an examination of the risk factors of IPV in this region is well-timed and important for the understanding of gender relations and gender-based violence.

Factors associated with linkage to care for HIV patients in Tajikistan.

There is a growing human immunodeficiency virus (HIV) epidemic in Tajikistan. This paper presents factors associated with linkage to HIV care among people aged 15 years and older in Tajikistan. This retrospective cross-sectional study used the Tajikistan Ministry of Health HIV registry data from patients diagnosed with HIV at age 15 years or older from 2000 to 2016. Chi squared tests and logistic regression models tested factors associated with linkage to care. A multivariable logistic regression model examined effect modifications. While linkage to care had an overall increase from 2000 to 2016, the odds of linkage were lower among certain sub-groups including among people in Dushanbe, men, people engaging in sex work, injection drug users, and older people. Regional differences exist with linkage to care, occurring least frequently in Dushanbe. While access to care and quality of care have increased significantly over time, findings suggest that linkage to care is low, especially in the capital city where many services are provided. Evaluation focusing on acceptability of HIV services should be undertaken to understand why certain people do not link with services. Additional research about the types of barriers to linking with HIV care is needed to increase linkage to HIV care.