Biosurveillance in Central Asia: Successes and Challenges of Tick-Borne Disease Research in Kazakhstan and Kyrgyzstan

Abstract

Central Asia is a vast geographic region that includes five former Soviet Union republics: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. The region has a unique infectious disease burden, and a history that includes Silk Road trade routes and networks that were part of the anti-plague and biowarfare programs in the former Soviet Union. Post-Soviet Union biosurveillance research in this unique area of the world has met with several challenges, including lack of funding and resources to independently conduct hypothesis driven, peer-review quality research. Strides have been made, however, to increase scientific engagement and capability. Kazakhstan and Kyrgyzstan are examples of countries where biosurveillance research has been successfully conducted, particularly with respect to especially dangerous pathogens. In this review, we describe in detail the successes, challenges, and opportunities of conducting biosurveillance in Central Asia as exemplified by our recent research activities on ticks and tick-borne diseases in Kazakhstan and Kyrgyzstan.

Examining the Acceptability of mHealth Technology in HIV Prevention Among High-Risk Drug Users in Treatment

“…Similarly, slowed information processing function may prevent the timely, appropriate consideration of risk variables during decision-making instances [15]. As a result of chronic drug use, related lifestyle experiences, and relatively poor health, a disproportionate percentage of people who use drugs experience NCI to the extent that it may be disruptive to their participation in treatment services, including decreased treatment engagement, poor treatment retention, and suboptimal medication adherence [16–21]. …”

Modeling a Theory-Based Approach to Examine the Influence of Neurocognitive Impairment on HIV Risk Reduction Behaviors Among Drug Users in Treatment

“…By examining the moderated mediation effect reported here, however, we now assert that this automatic process works differentially for subgroups of individuals: Individuals characterized by higher levels of NCI are less likely to benefit from the HIV risk reduction information conveyed by the intervention and, hence, are less likely to engage in HIV preventive behaviors. Because a significant proportion of PWUDs are characterized by NCI (14–20, 25–27, 29, 30, 33), our findings point toward the need for future studies to develop and test intervention strategies to better accommodate the potentially disruptive influence of NCI on key intervention outcomes.…”

“…Although the number of diagnosed HIV infections attributed to people who use drugs (PWUDs) has decreased in recent years (1), they still remain a priority population for the prevention of HIV because they represent a critical conduit for new HIV infections, and because this occurs through preventable drug-related (e.g., needle sharing) and sex-related (e.g., inconsistent condom use) HIV risk behaviors (2–6). As a result of chronic drug use, related lifestyle experiences, and relatively poor health (7–17), a disproportionate percentage of PWUDs experience neurocognitive impairment (NCI) to the extent that it may interfere with their ability to fully participate in treatment (18–20). It is well documented that HIV-infected PWUDs may experience cognitive impairment associated with the disease process (AIDS-related dementia) (14–17, 19, 21–27), but HIV- PWUDs also demonstrate levels of NCI that may be disruptive to their participation in treatment services (18, 28–31).…”

“…It is well established that some risk populations (e.g., PWUDs) are characterized by significant NCI, such that neurocognitive may play a substantial role in how they are able to respond to HIV risk reduction interventions (14–20, 25–27, 29, 30, 33). To date, however, there has been no examination of how NCI may impede one’s ability to accrue the expected HIV prevention benefits stemming from an otherwise efficacious intervention.…”

Neighborhood sociodemographics and change in built infrastructure

“…Features were assumed to remain stable until we noted a documented addition, removal or significant change. Additional details including the protocol for the collection and processing of the built environment data and the specific dates for CIPs and TIPs used for each city can be found elsewhere (Hirsch, Meyer et al 2016). …”