Characterising the public health response to HIV among people who inject drugs (PWID): the case of Kyrgyzstan

Thesis

HIV infection among people who inject drugs (PWID) remains a major global public health challenge. However, recent data indicate declining HIV incidence among PWID, prompting interest in the factors behind this trend, particularly in resource-constrained settings. This thesis examines the role of the public health response and broader contextual factors, using Kyrgyzstan as a case study.

The study is structured around five dimensions: providing background information on global, regional and country aspects of HIV and PWID (Chapter I); reviewing global evidence on effective HIV interventions for PWID (Chapter II); analysing how international guidelines draw on evidence, and how these guidelines are taken up in Kyrgyzstan’s HIV policies (Chapter III); modelling the impact of policies and other factors on historical HIV trends among PWID (Chapter IV); and projecting Kyrgyzstan’s potential to achieve UNAIDS 2030 targets of zero new HIV infections and AIDS-related deaths using prospective modelling (Chapter V).

The review found strong evidence supporting harm reduction interventions, such as needle-syringe exchange programs (NSP), opioid substitution therapy (OST), and behavioural strategies, in reducing high-risk behaviours and promoting health-seeking practices. Multi-component strategies combining behavioural and pharmaceutical interventions (for example, NSP, OST, ART), implemented at scale and sustained over time, were shown to be the most effective (Chapter II). Policy analysis revealed that HIV policymaking in Kyrgyzstan is largely rule-driven, guided by international guidelines rather than emerging local context (Chapter III). Retrospective modelling suggests that the decline in HIV incidence in Kyrgyzstan may partly reflect reductions in the PWID population, while existing interventions have played a significant role in mitigating the overall burden by preventing new infections and AIDS-related deaths (Chapter IV). Prospective modelling further indicates that Kyrgyzstan is unlikely to achieve the UNAIDS 2030 targets, even with intensified interventions and the potential introduction of long-acting PrEP, raising questions about the value of expanding interventions at this stage of the epidemic. Conversely, scaling down current interventions may lead to a resurgence of the epidemic, highlighting the importance of maintaining existing efforts (Chapter V).

Overall, this research highlights that epidemic trajectories are influenced not only by intervention effectiveness but also by societal and contextual factors. Policy decisions are most effective when context-sensitive and informed by diverse evidence and analytic tools. While international guidelines are valuable, countries benefit from tailored solutions implemented through close collaboration among researchers, practitioners, and policymakers.

Authors: Moldokmatova, A

• DOI: 10.5287/ora-qmkqnvj04
• Type of award: DPhil
• Level of award: Doctoral
• Awarding institution: University of Oxford
• Language: English
• Keywords: Kyrgyzstan; ART; harm reduction; People who inject drugs (PWID); HIV
• Subjects: Drug use--Kyrgyzstan