RISK MANAGEMENT OF MULTI-DRUG RESISTANT TUBERCULOSIS IN HOSPITALS OF CENTRAL ASIA: SYSTEMATIC REVIEW

Abstract

Background: Multidrug-resistant tuberculosis (MDR-TB) is a critical public health threat, especially in Central Asia, where a high proportion of new and previously treated TB cases develop drug resistance​. Hospital settings are focal points for MDR-TB transmission, underscoring the need for effective risk management strategies. This study systematically reviewed hospital-based MDR-TB risk management in Central Asian countries (Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan, Turkmenistan) to evaluate current strategies, their effectiveness, and gaps in implementation. Methods: The systematic review was performed in line with PRISMA 2020 guidelines. Relevant studies published in English or Russian between 2020 and 2025 were identified via PubMed, EMBASE, Cochrane Library, and Google Scholar. Inclusion criteria focused on studies reporting MDR-TB risk management interventions (infection control, treatment optimization, surveillance, adherence support) in hospital settings in Central Asia. Study quality and bias were assessed using ROBINS-I for non-randomized studies. Data on key MDR-TB risk factors, intervention strategies, and outcomes were extracted and presented in summary tables. A narrative synthesis was conducted, grouping studies by intervention type (infection control, diagnostics, treatment adherence). Results: A total of 11 studies were included, covering hospital-based MDR-TB management in Kazakhstan, Uzbekistan, Kyrgyzstan, Tajikistan, and Turkmenistan. Key risk factors for MDR-TB included previous inadequate TB treatment, delayed diagnosis, comorbidities (HIV, diabetes), and socio-economic determinants (poverty, homelessness, alcohol abuse). Implementation of WHO-recommended short-course regimens improved treatment success, with Kazakhstan achieving >90% success rates. However, barriers such as diagnostic delays, poor adherence support, and inconsistent infection control led to continued MDR-TB transmission in other regions. Emerging resistance to bedaquiline and fluoroquinolones poses a growing threat to treatment efficacy. Discussion: The included studies varied in quality and methodology, with some lacking control groups or long-term follow-up data. Additionally, limited surveillance data from Turkmenistan and Tajikistan restricted regional comparisons. This review highlights that MDR-TB risk management strategies are effective when implemented comprehensively but remain inconsistently applied across Central Asia. Strengthening rapid diagnostics, expanding access to all-oral short regimens, and improving adherence support are critical to reducing MDR-TB transmission and improving outcomes. Policy reforms should address gaps in surveillance and infection control to enhance hospital-based TB care.