Page 29 - GHES-2-4

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

with numerous publications identifying it as a barrier to sustain the Kyrgyz OAT program and provide a model for
treatment (Aizberg, 2008; Alieva et al., 2013; Eurasian other countries in Central Asia.
Harm Reduction Association, 2019; Katkalova, 2021;
Latypov et al., 2012; Subata et al., 2015; Yesenamanova Acknowledgments
et al., 2014). Despite these findings, the registration process None.
remains in place.
Funding
3.4. Comparison to neighboring countries
Funding for this research was provided through the
The Kyrgyz Republic has a strong, state-supported OAT National Institute of Drug Abuse (R01DA054851)
program, although with several challenges, as outlined and Fogarty International Center (D43TW010540,
above. Its enabling framework is considerably stronger D43TW012492).
than programs in neighboring countries. Russia,
Turkmenistan, and Uzbekistan do not currently have Conflict of interest
methadone programs–methadone and all other OAT
programs are explicitly banned. Uzbekistan introduced The authors declare that they have no competing interests.
methadone but discontinued the pilot program in Author contributions
2009 (Khachatrian, 2009). Meanwhile, programs in
Kazakhstan and Tajikistan are exceptionally small in Conceptualization: Frederick L. Altice, Amanda Liberman
terms of coverage, even when compared to the Kyrgyz Data curation: Ainura Kurmanalieva, Damira I.
Republic’s suboptimal coverage rate of 4.4% (UNAIDS, Biibosunova, Natalya Shumskaya
2022b). Similar to the Kyrgyz Republic, Kazakhstan and Formal analysis: Ainura Kurmanalieva, Damira I.
Tajikistan require mandatory registration for PWID. The Biibosunova, Natalya Shumskaya, Daniel J. Bromberg
methadone programs in Kazakhstan and Tajikistan also Resources: Ainura Kurmanalieva, Damira I. Biibosunova,
face numerous infrastructure challenges. Kazakhstan, for Natalya Shumskaya
example, has struggled with procurement issues, leading Writing – original draft: Amanda Liberman
to several program shutdowns (Kazakhstan Union for Writing – review & editing: Frederick Altice, Lynn Madden,
PLHIV et al., n.d.), endangering the lives of patients. In Roman Ivasiy
Tajikistan, the methadone program is limited to a few sites Ethics approval and consent to participate
in major urban centers, restricting access for much of the
population (Kluczewska and Korneev, 2021). Not applicable.

4. Conclusion Consent for publication
This article provides a review and timeline of the major Not applicable.
legislative benchmarks in the Kyrgyz Republic’s OAT
program, highlighting the stepwise policy changes that Availability of data
have supported the program’s sustainability since its All Kyrgyz Republic legislation is available through a state-
inception as a pilot in 2001. It also identifies areas where run database at https://cbd.minjust.gov.kg/.
improvements can be made to ensure the program’s
sustainability. The analysis included all laws relating to References
methadone, OATs, drugs/narcotics, and drug policies About Narcotic Drugs, Psychotropic Substances and Precursors,
in the Kyrgyz Republic from its founding in 1991 to Pub. L. No. 66. (1998). Available from: https://cbd.minjust.
March 2023, as well as comparisons with OAT programs gov.kg/act/view/ru-ru/74?cl=ru-ru [Last accessed on 2023
in other countries in the region. The article traces the Jun 01].
trajectories of OAT scale-up in relation to overall HIV Aizberg, O. (2008). Opioid Substitution Therapy in Selected
transmission, in particular, among PWID. It is evident Countries of Eastern Europe and Central Asia. Available
that the Kyrgyz Republic’s legislative framework has been from: https://rcn.kg/uploads/files/19jan-final-ost overview_
more supportive than those of other countries in the rus_Jan 92_2_.pdf [Last accessed on 2023 Aug 01].
region. Moving forward, implementing changes such as Alieva, G., Saiakova, M., & Yusupova, A. (2013). Michels, I.I.,
ensuring optimal methadone dosing (at least 80 mg per Iskakova, C., & Zelichenko, A. (eds.). Women and Addiction
day), expanding access to buprenorphine, eliminating in the Kyrgyz Republic. Available from: https://library.fes.
mandatory narcological registration, and improving law de/pdf-files/bueros/bischkek/10178.pdf [Last accessed on
enforcement interactions with OAT participants can help 2023 Aug 01].

Volume 2 Issue 4 (2024) 8 https://doi.org/10.36922/ghes.2536