Tuberculosis, drug use and HIV infection in Central Asia: an urgent need for attention.
BACKGROUND
Rates of tuberculosis in Central Asia are extremely high, and even more alarming are the very high rates of multidrug-resistant tuberculosis (MDR-TB) in Kazakhstan, Uzbekistan, Tajikistan and Kyrgyzstan. In addition, rates of HIV infection related to injection drug use seems to be rising as well, thus creating conditions for a potentially devastating co-epidemic of TB/HIV and MDR-TB/HIV which would have terrible consequences for public health in these countries.


RESULTS
In many countries of Central Asia, diagnosis of tuberculosis still rests on clinical grounds or simple technologies such as chest radiograph and sputum smear examination. Modern molecular techniques such as GenExpert are being introduced in Kazakhstan and Uzbekistan, and perhaps soon in Kyrgyzstan. Treatment of TB is still often centered around prolonged inpatient stay at TB hospitals. Only a minority of patients with HIV infection are receiving ART, and TB and HIV services are not well integrated. Needle exchange programs are becoming increasingly available, but opioid substitution therapy is rarely used in Central Asia. TB, drug treatment and HIV services are generally not well-integrated.


CONCLUSIONS
To combat this developing storm, integration of TB services, HIV care, and substance abuse treatment programs is needed urgently to allow efficient and effective diagnosis and treatment of these conditions in a coordinated manner.
Mailman School of Public Health, Columbia University, USA. Electronic address: ns311@columbia.edu.
Neil W
NW
Schluger
Nabila
N
El-Bassel
Sabrina
S
Hermosilla
Assel
A
Terlikbayeva
Meruyert
M
Darisheva
Angela
A
Aifah
Sandro
S
Galea
D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D001208:Asia / Q000453:epidemiology; D015897:Comorbidity; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*
D019380:Anti-HIV Agents; D000995:Antitubercular Agents
Central Asia; HIV; Injection drug use; Tuberculosis