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

were maintained on methadone at doses exceeding only country in Central Asia to provide take-home dosing,
80 mg/day (Bachireddy et al., 2022). which was expanded for methadone program participants
As described in Table 1, in 2015, clinical guidelines in 2020 during the lockdowns related to the COVID-19
were released for in-prison or pretrial detention pandemic. It is the only Central Asian country to provide
methadone treatment, covering post-admission and pre- clinical guidelines for buprenorphine as OAT, which was
release scenarios, such as treatment interruption. If the introduced in 2022, thereby allowing patients to choose
methadone treatment is interrupted by more than 2 days, their preferred OAT.
patients must follow a treatment initiation protocol. The most recent clinical protocol for methadone dosing,
Meanwhile, for interruptions of <2 days, patients can developed in 2022, is an update from the previous protocol
resume treatment at the previous dose after consulting with issued in 2015 (Ministry of Health of the Kyrgyz Republic
the site narcologist, a physician specializing in addiction and Republican Centre for Psychiatry and Narcology, 2022;
treatment. One month before their release, patients must Ministry of Health of the Kyrgyz Republic and Republican
decide whether to continue treatment post-release. If they Narcology Center, 2015). The current guidelines reflect
choose to discontinue the treatment, their clinician will a review of OAT policies by domestic and international
follow a dose tapering protocol; meanwhile, those wishing experts, as well as a review of the existing literature. The
to continue will be connected to a community methadone strengths of the updated protocol include the introduction
site (Republican Narcology Center, 2015). of buprenorphine as an alternative to methadone, an
emphasis on the importance of methadone for pregnant
3.2. Strategies to consider in other Central Asian or breastfeeding individuals, appropriate dosing
contexts recommendations including early dose escalation, and

The Kyrgyz Republic was an early adopter of methadone no maximum treatment duration. The protocol provides
compared with other Central Asian countries, and it has updated guidance for transitioning patients between
the most experience in the region. In 2001, it became the community and criminal justice settings, with the national
first Central Asian country to offer methadone treatment, OAT database allowing a patient to transition between
and in 2008, it became the first Central Asian country to sites. Although the protocol recommends psychological
offer methadone in prisons (on the extension of the State counseling for all methadone program participants, it does
Program for Prevention of HIV/AIDS Epidemic and Its not require it, meaning that some patients may not receive
Socio-Economic Consequences in the Kyrgyz Republic for psychological services alongside methadone treatment.
2006-2010 until 2012, 2011); it is now approved but not Finally, the updated protocol recommends doses of at
implemented yet in Tajik prisons. OAT was expanded to least 80 mg for most patients (previously 60 mg), though
pretrial detention (SIZO) in 2009 with the understanding that it allows for lower doses, and providers often prescribe
opioid use disorder (OUD) is a chronic, relapsing condition subtherapeutic dosing (Ivasiy et al., 2022).
that should be continuously treated irrespective of location.
3.3. Ongoing challenges to OAT in the Kyrgyz Republic
Ongoing collaborations between local and international
organizations have resulted in multiple reports aimed Despite the strengths of the framework, the methadone
at maximizing uptake and strengthening the country’s program in the Kyrgyz Republic is currently declining in
methadone program (Bachireddy et al., 2022; Ivasiy et al., terms of the number of participants and program sites,
2022; Katkalova, 2021; Latypov et al., 2012; Liberman et al., as shown in Table 1 and Figure 2 (Katkalova, 2021).
2021; Liberman et al., 2022; Moeller et al., 2009; Subata et The decrease in the number of sites is mainly due to the
al., 2015). The program’s strengths include sites in multiple consolidation of smaller sites into fewer, larger ones,
regions within and outside of prisons, the integration whereas the decline in the number of participants is a more
of a one-stop-shop care model at certain sites (where complex issue that is partially related to the introduction of
individuals can receive HIV treatment and other health stimulants, although opioids remain common (Katkalova,
care at the site where they receive methadone), the recent 2021). Notably, although the overall number of new cases
addition of buprenorphine to clinical guidelines for OAT, of HIV cases in the Kyrgyz Republic has remained steady
and state and political support for the program. At present, since the introduction of the OAT program, new HIV
funding for the program is divided between international cases among PWID have dropped dramatically from 2010
organizations (Global Fund and PEPFAR) and the state to 2022 (Figure 2).
budget, with plans to continue requesting international Table 2 summarizes the primary current legislative
funding until at least 2026 (Kyrgyz Republic Funding barriers to treatment scale-up and recommendations for
Request Form, 2022). Notably, the Kyrgyz Republic is the sustainable program improvement. Subtherapeutic dosing

Volume 2 Issue 4 (2024) 6 https://doi.org/10.36922/ghes.2536