Публикации

Список публикаций за 2012-2017 гг , читать 2012- 2017

1.  Scaling up HIV prevention efforts targeting people who inject drugs in Central Asia: A review of key challenges and ways forward
Azizbek A. Boltaev, Nabila El-Bassel, Anna P. Deryabina, Assel Terlikbaeva, Louisa Gilbert, Timothy Hunt, Sholpan Primbetova, Steffanie A. Strathdee

читать DAD_Boltayev_HIVPrevention_4875

Abstract:

Background: In Central Asia, between 33% and 72% of cumulative HIV infections has been attributed to
unsafe injection practices among people who inject drugs (PWID).
Methods: We reviewed the current status and trends of national efforts in Central Asian countries to control HIV among PWID, and also reviewed the key structural and health-systems-related challenges that facilitate drug-use-related HIV risk in Central Asia.
Results: The spectrum and scale of HIV prevention services targeting PWID vary considerably among Central Asian countries. In all countries, the potential impact of these interventions is hindered by several key features: a restrictive legal environment, poor performance of service providers, widespread opposition to harm reduction, deficient human resources and funding mechanisms, poor services integration, insufficient community involvement, and other structural factors.
Conclusions: Scaling up HIV prevention interventions in Central Asia will demand greater attention to the structural, health-care-related and social factors that facilitate HIV risk and impede service utilization among PWID. Multi-level combination prevention interventions should be developed with a focus on the sexual partners and risk networks of PWID, aiming at early detection of HIV, timely enrollment in HIV care, and retention in HIV care.

 

2.  Redressing the epidemics of opioid overdose and HIV among people who inject drugs in Central Asia: The need for a syndemic approach
Louisa Gilbert, Sholpan Primbetova, Danil Nikitin, Timothy Hunt, Assel Terlikbayeva, Azzi Momenghalibaf, Murodali Ruziev, Nabila El-Bassel

читать DAD_Gilbert_Opiod overdose

Abstract:

Background: Accumulating evidence suggests that opioid overdose and HIV infection are burgeoning intertwined epidemics among people who inject drugs (PWID) in Central Asia. To date, however, researchon overdose and its associations with HIV risks among PWID in Central Asia remains virtually absent. This paper aims to provide a regional overview of the hidden epidemic of overdose and how it is linked to HIV among PWID in Central Asia, using a syndemic framework that is guided by risk environment research.
Methods: We conducted a comprehensive literature search of peer-reviewed publications and gray literature on opioid overdose and its associations with HIV in five countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) as well as on policies and programs that addressthese co-occurring epidemics.
Results: Regional data indicate high rates of fatal and non-fatal overdose among PWID. Evidence suggests mortality rates from overdose exceed HIV/AIDS as the leading cause of death among PWID. The syndemic framework suggests multiple macro-level and micro-level environmental risk factors that drive the cooccurring epidemics of HIV and overdose. This framework identifies several interacting biological and behavioral risks that result in additive effects for HIV and overdose.
Conclusion: The high rates of overdose and its associations with HIV underscore the need for a syndemic approach that considers overdose on parity with HIV. Such an approach should focus on the biological, behavioral and structural interactions between these epidemics to reduce social suffering, morbidity and mortality among PWID in Central Asia.

 

3.  Tuberculosis, drug use and HIV infection in Central Asia: An urgent need for attention
Neil W. Schluger, Nabila El-Bassel, Sabrina Hermosilla, Assel Terlikbayeva, Meruyert Darisheva, Angela Aifah, Sandro Galea

читать DAD_Schluger_TB, HIV, IVDU in Central Asia

Abstract:

Introduction: 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.
Current status: 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.

4.  Access to HIV counseling and testing among people who inject drugs in Central Asia: Strategies for improving access and linkages to treatment and care
Assel Terlikbayeva, Baurzhan Zhussupov, Sholpan Primbetova, Louisa Gilbert, Nurmat Atabekov, Gusal Giyasova, Murodali Ruziev, Alijon Soliev, Daniiar Saliev, Nabila El-Bassel

читать DAD_Terlikbayeva_HIVTesting_4849

Abstract:

Introduction: As a population profoundly affected by the HIV epidemic and in critical need of linkages to HIV treatment and care, PWID in Central Asia remain largely underserved. This paper provides an overview of the current state of HIV testing and counseling in Central Asia for PWID, identifies main barriers leading to gaps in service delivery, and discusses implications for improving strategies that promote HIV testing for PWID.
Methods: We reviewed a number of sources for this paper including unpublished government reports, published papers, and Ministries of Health of Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan country progress reports to the UN General Assembly Special Session on HIV/AIDS (UNGASS) for 2012.
Results: Between 29 and 65% of PLWH in some Central Asian countries have been tested for HIV in the last 12 months. The rates have been increasing in the recent years but still are relatively low. Stigma, discrimination, human rights violations, and repressive legislation are barriers to HTC for people who inject drugs (PWID).
Conclusion: The use of innovative evidence-based HTC models, such as community mobile-vans, selftesting at home, and rapid HIV testing among PWID in Central Asia are discussed and recommendations given regarding amendments in legislation and scaling up of existing community-based pilot projects to support HIV testing among PWID in CA.

5.  Preliminary Population Size Estimation of Men Who Have Sex With Men in Kazakhstan: Implications for HIV Testing and Surveillance
Elwin Wu, Assel Terlikbayeva, Timothy Hunt, Sholpan Primbetova, Yong Gun Lee, and Mark Berry

читать 2017_LGBTHealth_EstimateionOfMSMInJKAZ(WuEtAl)

Abstract:

Purpose: The purpose of this study is to estimate the population size of men who have sex with men (MSM) in
Kazakhstan and their HIV testing history.
Methods: We conducted structured interviews with MSM in four geographically disparate cities—N = 400 (n = 100/city)—to implement four population estimation methods and ascertain HIV testing history.
Results: Approximately 3.2% of men—corresponding to*154,000 individuals—in Kazakhstan aged 18–59 are MSM. The 49.9% of the sample who reported taking an HIV test far exceeds the <1% reported as MSM in surveillance data.
Conclusion: HIV testing surveillance in Kazakhstan has underestimated the number of MSM. This underscores the need to redress social and structural barriers to HIV testing and disclosure of sexual behavior experienced by MSM in Kazakhstan. Recommendations include promoting cultural sensitivity among testing staff through quality assurance and regular training, and increasing protection and public awareness through antidiscrimination policy development.

6.  Risk Factors for HIV and Unprotected Anal Intercourse among Men Who Have Sex with Men (MSM) in Almaty, Kazakhstan

Mark Berry, Andrea L. Wirtz, Assel Janayeva, Valentina Ragoza, Assel Terlikbayeva, Bauyrzhan Amirov, Stefan Baral, Chris Beyrer

читать PLOS journal.pone.0043071

Abstract:

Introduction: Men who have sex with men (MSM) are at high risk for HIV infection. MSM in Central Asia, however, are not adequately studied to assess their risk of HIV transmission. Methods: This study used respondent driven sampling methods to recruit 400 MSM in Almaty, the largest city in Kazakhstan, into a cross-sectional study. Participation involved a one-time interviewer-administered questionnaire and rapid HIV screening test. Prevalence data were adjusted for respondent network size and recruitment patterns. Multivariate logistic regression was used to investigate the association between HIV and selected risk factors, and unprotected anal intercourse (UAI) and selected risk factors.
Results: After respondent driven sampling (RDS) weighted analysis, 20.2% of MSM were HIV-positive, and 69.0% had unprotected sex with at least one male partner in the last 12 months. Regression analysis showed that HIV infection was associated with unprotected receptive anal sex (AOR: 2.00; 95% CI: 1.04–3.84). Having unprotected anal intercourse with male partners, a measure of HIV risk behaviors, was associated with being single (AOR: 0.38; 95% CI: 0.23–0.64); very difficult access to lubricants (AOR: 11.08; 95% CI: 4.93–24.91); STI symptoms (AOR: 3.45; 95% CI: 1.42–8.40); transactional sex (AOR: 3.21; 95% CI: 1.66–6.22); and non-injection drug use (AOR: 3.10; 95% CI: 1.51–6.36).
Conclusions: This study found a high HIV prevalence among MSM in Almaty, and a population of MSM engaging in multiple high-risk behavior in Almaty. Greater access to HIV education and prevention interventions is needed to limit the HIV epidemic among MSM in Almaty.

7.  Preliminary Population Size Estimation of Men Who Have Sex With Men in Kazakhstan: Implications for HIV Testing and Surveillance

Elwin Wu, PhD, Assel Terlikbayeva, MD, Timothy Hunt, MS, Sholpan Primbetova, MS,Yong Gun Lee, MS,and Mark Berry, PhD

читать: LGBT-2015-0152-Wu_1P

Abstract:

Purpose: The purpose of this study is to estimate the population size of men who have sex with men (MSM) in Kazakhstan and their HIV testing history.
Methods: We conducted structured interviews with MSM in four geographically disparate cities—N = 400 (n = 100/city)—to implement four population estimation methods and ascertain HIV testing history.
Results: Approximately 3.2% of men—corresponding to*154,000 individuals—in Kazakhstan aged 18–59 are MSM. The 49.9% of the sample who reported taking an HIV test far exceeds the <1% reported as MSM in surveillance data.
Conclusion: HIV testing surveillance in Kazakhstan has underestimated the number of MSM. This underscores the need to redress social and structural barriers to HIV testing and disclosure of sexual behavior experienced by MSM in Kazakhstan. Recommendations include promoting cultural sensitivity among testing staff through quality assurance and regular training, and increasing protection and public awareness through antidiscrimination policy development.

8.  Оповещение партнера среди ВГС-положительных пар, употребляющих инъекционные наркотики

Марьям Л. Фамури, Стейси A. Шо, Асель Терликбаева, Луиза Гилберт, Тим Хант, Елена Розентальи Набила Эль-Бассель

читать: Partner notification_ Journal of Substance Use_RU

Аннотация:

Общая информация: В рамках настоящего исследования анализируются прогностические факторы оповещения партнера (ОП), подтверждаемые консультантом по вопросам тестирования, среди потребителей инъекционных наркотиков (ПИН) и их сексуальных партнеров в Казахстане.

Методы исследования: Мы использовали исходные данные исследования мероприятий по борьбе с ВИЧ, основанного на изучении пар, при этом выборка ограничивалась парами, в которых оба партнера знали о том, что они имеют вирус гепатита С (ВГС-положительны) до участия в исследовании (количество = 136 человек). Для изучения прогностических факторов оповещения партнера, включая социально-демографические характеристики, модели сексуального поведения и употребления наркотиков, ассоциируемые с риском инфицирования, а также доступ к медицинскому обслуживанию, использовались кросс-табуляция и логистическая регрессия.

Результаты: Из общего числа выборки 68 (50%) участников сообщили своим партнерам о своем ВГС-статусе. Факт оповещения партнера ассоциировался с участием исследуемых в программе обмена игл/шприцев и консультированием по вопросам, связанным с инфекциями, передаваемыми половым путем, или получением соответствующего обучения в течение предшествующих 6 месяцев. В скорректированной модели сопутствующая ВИЧ-инфекция (OR = 2.4, p <0.05), наличие нескольких сексуальных партнеров (OR = 2.5, p <0.05) и участие исследуемых в программе обмена игл (OR = 4.3, p <0.01) положительно связывались с фактом оповещения партнера в паре.

Заключения: Результаты данного исследования подчеркивают важность доступа к медицинским услугам среди ПИН и указывают на необходимость дополнительных исследований в области консультирования по вопросам ВГС и стратегий оповещения как компонента медицинских услуг, предоставляемых потребителям инъекционных наркотиков.

 

 

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