High Tuberculosis Burden in Central Asia and the Southern Caucasus

Tuberculosis remains a deadly global disease: in 2023 it caused an estimated 1.25 million deaths worldwide, including 161,000 among people with HIV. After a period in which COVID-19 briefly overtook it, TB has likely returned as the leading cause of death from a single infectious agent. Central Asia and the Southern Caucasus are among the regions still carrying a heavy TB load, and Mongolia stands out as having the highest reported prevalence. To clarify the current picture and help shape public health responses, a systematic review was carried out under the correspondence of Malika Idayat. The review brought together published studies that measured TB burden across countries in these regions, with the goal of summarizing what is known now and identifying gaps that need attention. By collecting and comparing available data, the authors aimed to give health officials, researchers, and funders a clearer basis for prioritizing surveillance, prevention, and treatment efforts in countries where TB continues to cause substantial illness and death.

The review used a comprehensive search strategy limited to English-language articles published up to 2023, searching PubMed and Google Scholar. Included studies were evaluated with a modified Newcastle-Ottawa Scale to assess quality and bias. Nine studies met the inclusion criteria and together covered Kazakhstan, Kyrgyzstan, Uzbekistan, Tajikistan, Turkmenistan, Mongolia, Georgia, Armenia, and Azerbaijan. Reported TB incidence varied across these settings, from 67 per 100,000 in Kazakhstan to 190 per 100,000 in Kyrgyzstan, while Mongolia showed a prevalence figure of 68.5%. The review found TB affected men more often (65.3% of cases) and identified key risk factors including HIV (30.5% of cases where reported), other comorbidities, and undernutrition. Drug-resistant TB was highlighted as a major concern not only for health but for finances: documented treatment costs for drug-resistant disease ranged from $106 to $3,125, underscoring an economic burden on patients and health systems.

These findings carry clear implications for public health planning in Central Asia, the Southern Caucasus, and Mongolia. The uneven incidence and extremely high prevalence in Mongolia suggest that national and regional responses must be tailored to local realities rather than relying on a one-size-fits-all approach. The identification of men, people living with HIV, those with comorbidities, and undernourished individuals as key affected groups points to where screening, prevention, and social support efforts could be concentrated. The substantial costs associated with drug-resistant TB make a strong case for investing in early diagnosis, effective treatment programs, and measures to prevent the development and spread of resistance. The authors emphasize the need to strengthen surveillance systems, improve routine data collection so that trends can be tracked reliably, and conduct longitudinal studies to understand how TB burden is changing over time; these steps are essential for designing and evaluating effective TB control strategies in the region.