Whole genome sequencing (WGS) is revolutionary for diagnostics of TB and its mutations associated with drug-resistances, but its uptake in low- and middle-income countries is hindered by concerns of implementation feasibility. Here, we provide a proof of concept for its successful implementation in such a setting. WGS was implemented in the Kyrgyz Republic. We estimated needs of up to 55 TB-WGS per week and chose the MiSeq platform (Illumina, USA) because of its capacity of up to 60 TB-WGS per week. The project’s timeline was completed in 93-weeks. Costs of large equipment and accompanying costs were 222,065 USD and 8462 USD, respectively. The first 174 WGS costed 277 USD per sequence, but this was skewed by training inefficiencies. Based on real prices and presuming optimal utilization of WGS capacities, WGS costs could drop to 167 and 141 USD per WGS using MiSeq Reagent Kits v2 (500-cycles) and v3 (600-cycles), respectively. Five trainings were required to prepare the staff for autonomous WGS which cost 48,250 USD. External assessment confirmed excellent performance of WGS by the Kyrgyz laboratory in an interlaboratory comparison of 30 M. tuberculosis genomes showing complete agreeance of results.
We propose using a simple Taylor rule to evaluate business cycle convergence of the Czech Republic, Hungary, and Poland with the Eurozone. Our findings indicate an ongoing convergence of those CEE countries to the Eurozone, but with instabilities and heterogeneity between the countries. Especially Poland has shown a high degree of convergence in recent years. But there are still relevant differences in Taylor rates of each country to the Eurozone of about two percentage points.
The Kyrgyz Republic is a transition economy. Its growth performance is constantly one of the lowest compared to other CIS countries. This bad performance is mainly due to a strong political instability and high corruption level. Despite being a leading reformer in the region, the Kyrgyz Republic has not done enough to solve key problems. This study employs the Growth Diagnostic approach proposed by Hausmann et al (2005) in order to identify the most binding constraints for economic growth. This paper finds that the high level of corruption, weak property rights, inefficient energy sector and low quality of the educational system are the most binding constraints for the Kyrgyz Republic's economic growth.
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