#2 (2022)

This retrospective cohort study included all TB cases reported in 2019-2020 (11908 cases). An analysis of the coverage of the drug sensitivity test was carried out with a study of the prevalence of resistance of various strains of the causative agent of tuberculosis to anti-tuberculosis drugs. Disaggregated data by TB form with drug susceptibility test results were taken from the registration forms.
The COVID-19 pandemic in the country negatively affected the detection of TB, a decrease by 32.2%, in the 2nd quarter of 2020 by 49% (р<0.001, ꭓ²), while in all regions of the republic there was a decrease from 16.3% up to 40%.
DST coverage of all reported TB cases, regardless of COVID-19, is only within 46%. Bacteriological confirmation of TB was only 56.9% and 59.4% in 2019-2020, COVID-19 did not affect this indicator (p>0.05).
The COVID-19 situation negatively affected the confirmation of the diagnosis in extrapulmonary forms of TB (p<0.001, ꭓ², OR=2.9, 95% CI 2.6-3.3), 2.9-3.8 times lower than than among pulmonary forms (60.1% and 61.8% in 2019-2020, p<0.001, ꭓ², OR=3.8, 95% CI 3.2-4.4).
Among TB patients with DST, the vast majority (61.4% and 59.2%) have MBT strains with some resistance, among which 37.6% and 35.0% are with M/XDR. In every 5th patient, strains with multiresistance of the pathogen were found.

Drug allergy (DA) is one of the main types of adverse events in multidrug-resistant tuberculosis (MDR-TB).
An allergic reaction develops under the influence of cytokines (CT). The aim of the study: the purpose of the study was
the production of interleukins IL-4, IL-6 and cytokine balance (CB) in patients with MDR-TB with DA. Materials and
methods. The object of the study was 80 MDR-TB patients with DA on anti-tuberculosis drugs according to clinical
signs. Treatment regimen: standard (SR) - 50/62.5%, short-term (ST) - 10/12.5% and individual (IR) – 20/25.0% of patients.
The average age is 34.0±3.8 years. The study material is blood serum. The research method is solid-phase enzyme
immunoassay (Sandwich method), «Awareness Technology» equipment and «Vector-Best» reagent kits. Spontaneous
production of IL-4 and IL-6 was studied. Design: a prospective and retrospective study. Statistical processing was carried
out using the SPSS16.0 software package. Results of the study. The concentration of IL-6 exceeded the norm in 38/47.5%,
IL-4 in 2/2.5% of 80 MDR-TB patients (p<0.05). There was a statistical difference between IL-4 and IL-6 (p<0.05) in
terms of SR and IR. The CB made up: SR (18,1±3,0/1,3±0,1=13,9), IR (31,4±5,8/2,7±0,2=11,8) and ST
(15,3±4,5/3,2±0,3=4,8). Consequently, the most active inflammatory allergy reaction was noted in SR (CB=13.9). Conclusion.
The study of the production of IL-4, IL-6 and the IL-6/IL-4 ratio contributes to the assessment of the activity of
the allergy inflammatory response in DA in MDR-TB patients.

The article describes the situation of drug resistance of the causative agent of tuberculosis, provides data on
the effectiveness of anti-tuberculosis therapy in patients with pulmonary tuberculosis with multidrug resistance, as well
as indicators of the success of treatment of RU/MDR TB in short-term and individual regimens. The indicators of treatment
coverage of patients with RU/M/XDR TB, the proportion of pulmonary and extrapulmonary forms, age-sex structure,
categories of previously treated and new cases were studied. Data on a cohort of cases confirmed by various tests for
drug sensitivity are presented. An important place is given to the study of the growth rates of cases with TB and HIV coinfection
in 2019- 2020. The important role of patients' access to antiretroviral therapy due to the limitations associated
with the COVID-19 pandemic was noted. According to the results of the study, an unreliable increase in the proportion
of XDR TB cases was established, the highest level of XDR TB in Jalal-Abad, Osh regions, the State Penitentiary Service
and the city of Osh, among which the share of XDR TB in the Osh region increased by more than 2 times. The analysis
of the results showed the need to increase the coverage of short-term treatment regimens due to the high success rates of
treatment of RU/MDR TB than other regimens. However, in the Kyrgyz Republic, the percentage of coverage of shortterm
innovation regimes in the country does not exceed 12%. High success rates of treatment of RU/MDR TB with shortterm
and individual regimens, including Bdq/Dlm, have been established. The effectiveness of XDR TB treatment in IR
therapy with new drugs is higher than without their inclusion.

The relevance of the problem of timely microbiological diagnosis of extrapulmonary tuberculosis using molecular
genetic methods retains its significance. Comparison of the results of testing the sensitivity/resistance of MBT to
anti-tuberculosis drugs by microbiological, molecular genetics and histological methods of resection specimens isolated
from the clinical material of patients with extrapulmonary forms of tuberculosis. For the study, state reporting forms No.
8 “On diseases with active tuberculosis” and No. 089 / y-tube “Notice of a patient with tuberculosis”, registration forms
TB 06 - table 3b were used: “Results of testing drug sensitivity to drugs of the first and second line of patients with extrapulmonary
TB ”, registration forms TB-06 No. 003 / U (case history) of 104 patients with extrapulmonary tuberculosis
who were treated in 2021 at the National Center for Phthisiology. The use of the molecular genetic method of the Hine
test made it possible to obtain a higher percentage of positive results for the detection of MBT in comparison with microscopy
and cultivation methods. When comparing these positive results of the Hine test, highly reliable results were
found. When studying the drug resistance test of MBT strains to first-line drugs, there were no significant differences
between the Hain-test method in relation to both cultural methods in detecting MBT strains with preserved sensitivity to
first-line drugs, with PDR and MDR. When comparing these positive results of the Hine test, highly reliable results were
found. So, in comparison with the cultural Lowenstein-Jensen, there are significantly significant differences.

Prevalence of multidrug-resistant (MDR) TB strains in patients with extrapulmonary TB. The aim of the study
was to analyze the prevalence of the resistance profile of the causative agent of multidrug-resistant tuberculosis (MDR)
among patients with extrapulmonary tuberculosis (TB). To study the prevalence of MDR-TB among patients with extrapulmonary
tuberculosis, state reporting forms No. 003/U (case histories of patients with extrapulmonary tuberculosis,
and the electronic database of the National Reference Laboratory of the National Center for Phthisiology) were used.
Among the results of drug resistance tests of drug-resistant forms, the largest share is made up of strains of the causative
agent of TB with MDR-TB in 43 (61.4%) cases. The results of tests with polyresistance were 25 (35.7%) cases. XDR
strain of the causative agent of tuberculosis was detected in two cases - 2.9%. Despite the introduction of the DOTS strategy
and a decrease in TB incidence, prevalence, and mortality among the population, the Kyrgyz Republic has a high
level of MDR-TB among patients with extrapulmonary TB.

A high level of common immunoglobulin E (IgE) indicates a high likelihood of an allergic reaction.The aim
of the study: was to identify drug allergy (DA) by quantitative determination of common IgE in patients with multi-resistant
tuberculosis (MDR TB). Materials and methods. The object of the study was 80 MDR-TB patients with clinical
signs of DA. In the group of the standard treatment regimen (SR): 50/62.5% of patients (23/46.0% women and 27/54.0%
men, 34.9±2.8 years). In the group with an individual regime (IR): 20/25.0% of people (6/30.0% of men and 14/70.0%
of women, 36.0±3.5 years). In the short-term regimen group (SR): 10/12.5% of patients (2/20.0% men and 8/80.0%
women, 31.0±5.2 years). The study material is blood serum. The research method is solid-phase enzyme immunoassay.
Design: a prospective and retrospective study. For statistical processing, the SPSS16.0 software package was used.
Results of the study. The presence of DA at a high level of IgE was determined in 39/48.8% of MDR-TB patients. With
SR treatment, the highest level of IgE (423.2±62.7IU/ml) was noted in comparison with IR and SR. The concentration
of IgE in MDR-TB patients with DA is significantly higher (p<0.05) compared with the level of IgE in MDR-TB patients
without DA. The concentration of IgE in MDR-TB patients with DA is significantly higher (p<0.05) compared with the
level of IgE in pulmonary tuberculosis patients with drug sensitivity of mycobacteria with DA. Conclusion. The quantitative
determination of the concentration of common nonspecific IgE can be used in the detection of DA in MDR-TB patients.

Tuberculosis (TB) in children is characterized by the frequency of extrapulmonary localization of the process,
the rarity and scarcity of bacterial excretion. WHO recommends that in order to improve the effectiveness of TB diagnosis,
studies of any available diagnostic material should be carried out using all available laboratory methods. The purpose of
this study was to study the informativeness of various types of diagnostic material samples for the detection of M. tuberculosis
in children. Material and methods.A retrospective analysis of the results of microbiological studies on Mycobacterium
tuberculosis in 1,676 children under the age of 15 for the period 2017-2021, performed in the Republican Reference
Laboratory of the National Center of Phthisiology. Results. The most informative samples were biopsies/ resection material,
the contents of fistulas, bronchial flushing water and cerebrospinal fluid. The sensitivity of rapid molecular methods
of TB diagnostics (Xpert MTB/RIF, GenoTypeMDRTB plus) was higher compared to the results of culture (MGIT, LJ)
and microscopy. Conclusion. The cumulative informativeness of various types of diagnostic material samples in the laboratory
diagnosis of TB in children was 11.4%. As an initial diagnostic test, fast molecular methods are recommended to
verify the diagnosis of TB and start its adequate treatment.

The immune status and result of culture Mycobacterium tuberculosis (M. tuberculosis) were compared in
newly diagnosed patients with pulmonary tuberculosis (TBL) during chemotherapy. Upon admission, 51 patients were
examined. Research material for the presence of M. tuberculosis: sputum and blood of patients with TBL using methods:
polymerase chain reaction (PCR) and culture on Levenshtein-Jensen medium. For PCR, amplification was carried out
on a T1 thermal cycler (Biometra). The immune status was studied by the method of indirect immunofluorescence reaction
(RIF) with monoclonal antibodies CD3+, CD4+, CD8+, CD19+ and the ratio of CD4+\CD8+ (immunoregulatory index
- IRI) was calculated. Job design is a prospective study. Statistical processing SPSS16.0 programs using. The value of
the Fisher angular transformation φ was determined and confidence intervals of CI were calculated (M±tm; t=2.0; p<0.05).
Result of study: all patients with TBL had a positive PCR result. A positive result of the culture method (culture+) was
noted in 38/74.5% of 51 examined patients with TBL at admission. After 2 months of chemotherapy PCR+ was in all examined
TBL patients, culture+ was detected in 11/47.8% of 23 patients. The combined use of PCR and culture showed
a reduced detection of M. tuberculosis during chemotherapy (p<0.05). Upon admission, 74.5% of M. tuberculosis using
culture was detected. After 2 months of treatment, 47.8% of M. tuberculosis was detected. In the course of chemotherapy
in the culture-positive group, there was an increase (p<0.05) in most parameters of cellular immunity (CD3+, CD4+,
CD8+). In the culture-negative group, there was an increase (p<0.05) in CD3+ and IRI. Thus, studies have shown the relationship
between cellular immunity and the result culture of M. tuberculosis.

Kyrgyzstan has one of the highest rates of drug-resistant tuberculosis (TB) in the world. People at risk of TB
are often among the most hard-to-reach populations, which can make it difficult for them to access health care services.
The study identified enabling factors and barriers to testing and completing treatment for TB patients, causes and types
of stigma and discrimination against TB patients and their families, and widespread misinformation about TB among the
population.

A Quality of TB Services Assessment was conducted in Kyrgyzstan with a special module designed to assess
the impact of COVID-19 on TB services. Results demonstrate widespread disruption to TB services across all areas, including
reallocation of TB resources to COVID-19, decreased TB case detection and treatment, and impacts on infection
control. Results also show significant uptake of measures implemented to mitigate the impact of COVID-19 on TB services,
including patient-centered services. There is a need to refocus efforts and investment on TB in order to remedy the
impacts on the TB control system.

Introduction. According to the World Health Organization, the Kyrgyz Republic is among the 18 countries
with a high prevalence of multidrug-resistant tuberculosis. The molecular epidemiology of tuberculosis infection, including
genetic diversity, markers of molecular drug resistance, and transmission routes of Mycobacterium tuberculosis complex
strains in the Kyrgyz Republic, remain poorly understood. Whole genome sequencing (WGS) has been used to
determine the molecular genetic structure of the strains circulating in the country. Purpose of the study. The purpose of
the study was to describe the molecular genetic characteristics of strains of the Mycobacterium tuberculosis complex
based on the whole genome sequensing. Materials and methods.Whole genome sequencing was carried out at the National
Reference Laboratory of the National Center for Phthysiology under the supervision of the SNRL, Borstel, Germany.
475 MTBС isolates were tested in 2018 and 2019. Sequencing was performed according to the manufacturer's instructions
on the MySeq platform, Illumina, USA. The MTBSeq protocol was used for comparative genomic analysis and the online
tools “EvolView and PhyResSe” to perform graphical representation and screen for mutations mediating resistance to
antituberculous drugs. Stata/IC version 16.1 was used for statistical analysis.Results. Using WGS, showed that the MTBC population structure in the Kyrgyz Republic mainly consists of three phylogenetic
lineages (L). These lines are L2 (Beijing), L3 (Delhi/CAS) and L4 (Euro-American) as classified by Coll, Mc-
Nerney and Niemann, Merker. The L2 strains were predominant (74.1%, 352/475), while the L3 and L4 strains accounted
for 0.8% (4/475) and 25.1% (119/475), respectively. Next, we classified the L2 and L4 strains into several MTBC sublineages.
The Beijing Central Asia (n=225), Beijing Central Asia outbreak (n=75) and Beijing Europe/Russian W148
Outbreak (n=28) subline strains are the most common strains compared to the other L2 subline strains and the L4 subline
strains. Conclusions. Using WGS, have shown that pulmonary tuberculosis in the Kyrgyz Republic is mainly caused by
L2 (Beijing) strains. Drug resistance is also associated with L2 strains, highlighting the important role of L2 strains in
the epidemiology of tuberculosis in the country. Overall, our results provide a better understanding of the molecular epidemiology
of tuberculosis in the Kyrgyz Republic and require additional molecular epidemiological studies to elucidate
the dynamics of tuberculosis in the country and, therefore, control it.

Administration of Bedaquiline, Pretomanide and Linezolid - BPaL is a new fully oral 6-month regimen consisting
of bedaquiline, a new TB drug pretomanide and linezolid approved by WHO to use in operational research conditions
for the patients with drug-resistant tuberculosis (DR-TB).
Review of the situation and estimation of the TB drugs cost for treatment of the one patient according to the BPaL regimen
in comparison with the conventional treatment regimens for DR-TB.
The National Center of Phthisiology (NCF), with the support of KNCV, has started preparing for the use of the BPaL
regime in the Kyrgyz Republic (KR) since 2021. During this period, a guide on the use of BPaL in the Kyrgyz Republic
was prepared, which was signed by the Ministry of Health of the Kyrgyz Republic in early 2021. Training materials
were prepared, according to which all key specialists of the tuberculosis service were trained, with a focus on the central
council and the Republican Tuberculosis Hospital (RPTB) in Kara-Balta, where treatment of all patients on BРaL
was planned. despite the availability of regulatory documents, trainings, availability of drugs and eligible patients the
patient’s enrolment going slowly. Introduction of the BPaL regime over the next 3 years can save the state up to
460,000 US dollars.
The BPaL treatment regime can help the country significantly improve the effectiveness of treatment success rate of
the patients with DR-TB and rational use of the State and the Global Fund budget used for the procurement of the second-
line TB drugs for the Kyrgyz Republic.

Adverse reactions to drugs are a serious public health problem, which entails economic consequences: lengthening
the length of the patient's stay in the hospital, the need to individualize treatment regimens with the inclusion of
expensive reserve drugs, additional drugs and drugs to stop adverse reactions. The most problematic issue in the treatment
of tuberculosis is inadequate adherence to treatment, due to its duration, complexity and associated adverse events, leads
to the choice of a much more difficult and expensive treatment for multidrug-resistant tuberculosis. Inadequate treatment
adherence occurs despite extensive global efforts by the World Health Organization, ministries of health and others to
implement a highly labor-intensive TB treatment program that includes direct observation of treatment by public health
workers.
Treatment of tuberculosis involves the simultaneous and long-term use of four to eight drugs, each of which has a wide
range of possible adverse effects. Most anti-TB drugs are well known and have been studied in clinical trials. However,
individual signs and symptoms of adverse events, such as skin rashes, abdominal pain, jaundice, shock, visual impairment,
hearing impairment, can cause severe consequences for patients stopping taking drugs, reducing the quality of life and
complicating daily activities. The frequency of occurrence of adverse reactions to drugs in patients with tuberculosis was
studied on the basis of received message cards / yellow cards for 2020-2021. in the Kyrgyz Republic.

Tuberculous meningitis is one of the most severe forms of extrapulmonary tuberculosis. It often leads to disability
and death of patients.
The work retrospectively studied 95 case histories of patients who were in a specialized department of the National Center
for Phthisiology under the Ministry of Health of the Kyrgyz Republic.
The medical and social characteristics, indicators of clinical and laboratory research methods and the effectiveness of
complex treatment of patients with tuberculous meningitis were studied. Almost all patients showed signs of damage to
the substance of the brain (menigoencephalitis), which indicates a late diagnosis of tuberculosis. The most sensitive
method for detecting the causative agent of tuberculosis in the cerebrospinal fluid turned out to be the molecular genetic
method (GenXpert MTB/RIF). A high mortality rate was established for tuberculous meningitis (55.8%). The main cause
of death of patients was late detection of the disease, generalized forms of the tuberculosis process and severe concomitant
diseases.

The article presents data on the impact of the COVID-19 pandemic on the implementation of anti-tuberculosis
measures, in particular on the detection of tuberculosis cases in the Kyrgyz Republic. To achieve this goal, the reporting
data of the Department of Informatics and Epidemiology of the National Center of Phthisiology for 2019-2020 were
taken. The analysis included data on the number of reported cases of tuberculosis (TB), morbidity and mortality from
TB in 2019-2021. According to the NCF, epidemiological indicators such as morbidity and mortality from TB in 2020
compared to 2019 decreased significantly: the incidence of tuberculosis by 3.3 times (from 78.9 to 53.5, OR =3.3, 95%
CI 1.8-6.2, χ2 and mortality did not change, remaining at 3.9). A significant decrease in the incidence of tuberculosis (by
32.2%) is associated with a decrease in detection due to the COVID-19 pandemic. The TB service had difficulties in
staffing during the pandemic, which certainly led to a deterioration in the service of TB patients. The incidence of tuberculosis
in 2021 shows an improvement in the diagnosis of tuberculosis and an increase in the number of registered cases
(58.9 cases per 100 thousand population). Over the past 4 years, the highest incidence of tuberculosis in the republic has
been observed in the Chui region (124.2-88.2), then in the regions with a large population – Bishkek (88.8-59.7), Jalal-
Abad (73.3-55.6) and Osh region (75.0-55.9), and the lowest indicator is in Issyk-Kul region (48.9-37.5).

The article presents the situation with tuberculosis in the penitentiary system, the dynamics of incidents and
mortality rates from tuberculosis, in comparison with the civil sector from 2015 to 2020. The data of accounting and reporting
forms of the NTP for the penitentiary system of the Kyrgyz Republic were used. The TB incidence rate in the
penitentiary system in 2015 as a whole was 2240.2 cases per 100,000 population and decreased by 28% over 6 years in
2020, and the TB mortality rate by 14.2%. In the penitentiary system in 2015, there were 3.7 times more new TB cases
than relapses and 8.5 times more than other previously treated cases (p<0.001, χ², OR=3.7, 95% CI 2, 6-5.4 in the first
comparison and p<0.001, χ², OR=8.5, 95% CI 5.7-12.8 in the 2nd). After 5 years, there is a significant increase in the
proportion of new TB cases up to 8 times compared with relapses (p <0.001, χ², OR=8.1, 95% CI 3.5-8.1) and 11 times
compared with previously treated cases (p<0.001, χ², OR=11.4, 95% CI 4.8-27.7). The improvement in the proportion of
new cases is closely related to improved early detection of TB and frequent screening among prisoners (questionnaire,
chest x-ray and rapid diagnostic method). In2015, Xpert-MTB/Rif coverage among reported TB cases were 69.5% and
in 2020 it were 83.8%.

This article reflects the results of an assessment of the current state and dynamics of the epidemiological situation
of tuberculosis (TB) in children and adolescents in the Kyrgyz Republic (KR) for the period 2011-2020. Statistical
reporting data of the Center for e-Health under the Ministry of Health of the KR and the Department of Informatics and
Epidemiology at the National Center for Phthisiology of the Ministry of Health of the KR for 11 years (2010-2020) in
the KR, in the Chui region and Bishkek were used. The main epidemiological intensive indicator of the incidence of TB
in children and adolescents is analyzed, and the impact of the coronavirus infection pandemic on the prevalence of TB
among children and adolescents is shown. The incidence of TB among children and adolescents in the KR, Chui region
and Bishkek during the indicated observation period remains at a fairly high level and a gradual decrease in this indicator
is observed. Compared to 2010, the most significant decrease in the incidence of TB in children and adolescents has been
noted since 2017. However, a sharp decrease in the incidence of TB among children and adolescents in 2020 compared
to 2019 tends to decrease, so in the KR in children by 65.3%, in Chui region in children by 46.8%, in adolescents by
51.0% and in Bishkek in children by 73.5%, in adolescents by 75.1%, respectively. In general, in the republic, Chui
region and Bishkek, over the past decade, there has been a decrease in the incidence of TB among children and adolescents.
In 2020, this indicator tended to decrease sharply, which is associated with the coronavirus infection (COVID-19) pandemic.

Over the analyzed 12 years, this indicator of the incidence of tuberculosis has a statistically significant upward
trend – from 54.9 to 59.2 p <0.001. The incidence of tuberculosis among employees of medical organizations is 51.2-
51.3 thousand specialists, primary health care physicians have a statistically significant trend in the incidence of tuberculosis-
60.2 - 49.7 and only in anti-tuberculosis institutions (ПTO)-274.8-84.3. Despite the active implementation of
infection control measures in all medical organizations over the past 12 years, there has not been a significant decrease
in the incidence of tuberculosis in organizations of the general medical industry, there is a downward trend in 24.3 cases
of tuberculosis in 2019 compared to 274.8 cases in 2008.

This article is devoted to the dynamics of morbidity and mortality from 2014 to 2018 from TB among the general
population and among patients with HIV infection in the Kyrgyz Republic. The number of HIV-infected patients
with tuberculosis, the proportion of patients at risk of TB infection among HIV-infected patients and the general population,
the percentage of HIV-infected patients who received tuberculosis chemoprophylaxis was determined using national
case records, state registers, data from departmental statistical reporting materials, data from TB and state statistical services,
as well as materials from countries' regular reporting to WHO and UNAIDS. The authors of the article also used information
from open sources: publications and databases of international organizations, program and internal
documentation of relevant institutions. The authors point to the influence of risk factors for the development of tuberculosis
in patients with HIV infection, as well as the effect of ART among patients with HIV infection and HIV/TB on the
incidence of tuberculosis.

For the first time in more than a decade, due to the COVID-19 pandemic, TB deaths have increased due to
limited access to TB diagnostics and controlled treatment. Patient-centered TB treatment should be organized taking into
account the capabilities of patients. In the time of developing innovative, digital technologies in medicine, one of the effective
methods of TB treatment is an approach using digital health elements, in particular, video supported treatment.
Video-supportive treatment is more actual in resource-limited settings, emergencies, and in situations where face-to-face
contact between healthcare workers and patients is difficult and problematic.

Young children represent a special risk group for tuberculosis. In young children, tuberculosis proceeds less
favorably than in older children, and is characterized by a tendency to generalize the infection. Most often, the generalization
of the process occurs in unvaccinated children. BCG vaccination protects young children from the most severe
forms of TB such as miliary TB and TB meningoencephalitis. Lack of alertness, insufficient knowledge of medical workers
on early detection of tuberculosis leads to late diagnosis of the disease and disability of children. Two clinical cases
of late diagnosis of young children from close family contact who developed severe forms of generalized tuberculosis,
one of them with a fatal outcome, are presented. Purpose of the study. To study the consequences of late diagnosis in unvaccinated
young children from close family contact. Material and methods of research. Clinical cases of children - girl
P. N. 1 year 6 months. with a diagnosis of acute miliary tuberculosis. MM-. Tuberculous meningoencephalitis. brain
coma. and a boy R.A., 2 years, 9 months old with a diagnosis of Acute miliary pulmonary tuberculosis. MM-. PreSLU
by contact. Tuberculous meningoencephalitis. brain coma. Results. Due to the late diagnosis of tuberculosis in unvaccinated
young children, generalized processes developed from close family contact.Conclusion. The lack of alertness, insufficient
knowledge of tuberculosis among doctors leads to late diagnosis and the development of generalized processes
in unvaccinated young children.

Presented a clinical case of a student A.A., 23 years old with a diagnosis of infiltrative tuberculosis of the
upper lobes of the lungs. Abdominal tuberculosis: tuberculosis of the intestine, tuberculosis of the peritoneum, mesenteric
lymph nodes. Genital tuberculosis: bilateral tuberculosis salpingitis in the infiltration phase complicated by a small intestinal
fistula. Аctive stage. Ascites. MDRTB (HRZ).

This cross-sectional study used quantitative and qualitative methods to collect data. The sample of respondents
was carried out by the method of simple random sampling from the general list of registered cases of tuberculosis in
2021. A selected 120 TB patients were interviewed and collected data from primary medical records to study patient satisfaction
with services obtained through the process of TB detection in primary health care organizations and private
health care providers in Chui oblast and Bishkek city.
The study found that in favor of private medical providers such parameters as the quality of services (p-value<0.01 and
CI 7.3-107.2) play a decisive role; making an appointment (p-value<0.01 and CI 2.6-20.0); own vehicle (p-value-0.01
and CI 1.7-81.6); speed of diagnosis (p-value-0.01 and CI 1.3-10.5), availability of narrow specialists (p-value-0.01 and
CI 1.1-3.3); access to X-ray examination (p-value<0.01 and CI 1.9-7.6); as well as telephone feedback from health workers
to the patient (p-value<0.01 and CI 1.5-8.0).
The median delay in seeking care from the onset of TB symptoms was 36-37 days regardless of provider ownership
(range 0-247 days, median 27 days). The delay in starting treatment from the first symptoms of TB was about 45 days
for both compared groups. The delay in registration of TB cases was recorded in 22% of cases, 20% of which were
patients identified in the Bishkek CHMP, the delay in registration reaches 32-35 days after the start of treatment.
Respondents who received services from private medical providers showed greater satisfaction with the services, 95%
rated the services as "excellent" and "good". Whereas, only 78% were also rated by respondents who received services
in primary health care organizations.