Page 23 - GHES-2-4

Global Health Economics and
Sustainability
OAT in Central Asia: Kyrgyz Republic

1. Background methadone in the Kyrgyz Republic were compared with
similar laws from the neighboring Kazakhstan and
While the incidence and mortality of human Tajikistan (Republic of Kazakhstan, n.d.; Republic of
immunodeficiency viruses (HIV) have declined in other Tajikistan, n.d.). Notably, neither of the other two Central
regions over the past decade, in Eastern Europe and Asian countries (Uzbekistan and Turkmenistan) currently
Central Asia (EECA), HIV-related incidence and mortality provide OAT, although methadone was briefly introduced
are increasing (Nachega et al., 2023; UNAIDS, 2022a). The and discontinued in Uzbekistan (Khachatrian, 2009). The
epidemic is driven by the injection of opioids, for which Kyrgyz Republic, Kazakhstan, and Tajikistan all provide
maintenance with opioid agonist therapies (OATs), such as laws in Russian as well as in Kyrgyz, Kazakh, and Tajik,
methadone or buprenorphine, is among the most effective respectively; therefore, legal analyses were conducted in
strategies (Alistar et al., 2011; Degenhardt et al., 2019a; Tan Russian by bilingual research team members (ARL, AK,
et al., 2019; Ward et al., 2022). A systematic review found RI, and DJB).
that OAT is associated with an average 54% reduction in
HIV incidence among people who inject drugs (PWID; 3. Results and discussion
MacArthur et al., 2012), and it is now considered the global
standard of care for opioid use treatment (Degenhardt et Table 1 provides a history of key legislation and policy
al., 2019b). To effectively decrease HIV incidence among changes throughout the Kyrgyz Republic’s methadone
PWID, OAT should cover at least 20% and preferably 40% program. Key moments include the approval and launch
of PWID (World Health Organization [WHO] et al., 2009). of the first OAT site in the Kyrgyz Republic in 2001, the
In EECA, however, OAT coverage has remained minimal development of the first formalized methadone clinical
at best – many EECA countries do not offer this life-saving protocol in 2010, the expansion of take-home dosing
intervention and those that do often only provide it as pilot to all methadone program participants in 2020, and the
programs. In particular, the Russian Federation, a major introduction of buprenorphine as an OAT modality in
influencer in the region, legislatively bans any form of OAT 2020. Figure 1 presents a map indicating when the first non-
and seeks to influence its neighbors. penitentiary methadone site opened in each Kyrgyz city.
Figure 2A presents a timeline of the OAT census by year,
In the Kyrgyz Republic, the HIV prevalence among and Figure 2B shows the number of new HIV cases per year
PWID is 60 times higher than that among the general in the Kyrgyz Republic among all individuals and PWID.
population (18% vs. 0.3%; Joint UN Programme on From 2010 to 2022, PWID has gone from representing
HIV/AIDS, 2023). The Kyrgyz Republic is one of the few nearly two-thirds of new HIV cases to representing only
Central Asian countries to provide methadone, although about 2% of new cases (Republican AIDS Center of the
coverage remains low at approximately 4.4% (UNAIDS, Ministry of Health of the Kyrgyz Republic, n.d.). PWID
2022b). This is comparable with other countries in EECA began representing less than half of new HIV cases in 2012,
offering methadone: 7.1% in Ukraine, 0.4% in Kazakhstan, at the same time as the rapid expansion of the OAT census
and 2.7% in Tajikistan. The Kyrgyz Republic was the first in the Kyrgyz Republic.
country to initiate OAT in Central Asia and has the most
experience with this intervention in the region. Moreover, 3.1. Introduction of OAT into the criminal justice
it is the first and only country in Central Asia to provide system
take-home dosing and OAT in the criminal justice In August 2008, a pilot OAT program was launched in
system, with both programs still in operation. This article Kyrgyz Republic’s Colony No. 47, a penal institution,
reviews the history and policies related to methadone earning praise from the WHO for its organizational and
in the Kyrgyz Republic, as well as potential barriers and clinical effectiveness, given the prevalence of within-prison
suggestions for sustainable methadone scale-up in the drug injections (Azbel et al., 2018). This program led to
country. reduced injection drug use among inmates, lowered risk of

2. Methods transmitting HIV, improved quality of life, and enhanced
overall health (Subata et al., 2015). In 2009, two additional
All laws relating to methadone, OAT, drugs/narcotics, OAT sites were established, extending the program to the
and drug policy were reviewed from 1991 (the country’s pretrial detention center in the Kyrgyz Republic. By June
founding) to March 2023 through the official legal databank 2021, a total of 14 OAT sites were operational in prisons,
of the Kyrgyz Republic (Ministry of Justice of the Kyrgyz serving nearly 400 patients (Republican Narcology Center,
Republic, n.d.). This analysis also included official reports n.d.). The findings from the methadone program in Kyrgyz
from international funding organizations about the Kyrgyz prisons showed early substantial scale-up and increased
methadone program. In addition, relevant laws governing linkage to treatment after release, especially when patients

Volume 2 Issue 4 (2024) 2 https://doi.org/10.36922/ghes.2536