The Launch of the Partnership: 2003–2011 

For many years, the Kyrgyz Republic remained one of the countries with the highest burden of multidrug-resistant tuberculosis (MDR-TB) in the WHO European Region. Tuberculosis was not merely a medical issue; it was deeply intertwined with poverty, domestic migration, and social instability, placing an enormous burden on the healthcare system. 

In 2003, the programs of the Global Fund to Fight AIDS, Tuberculosis and Malaria were introduced to the country. This partnership provided large-scale funding for procuring medicines and implementing international standards of treatment. In 2011, at the request of the Country Coordinating Committee, UNDP assumed the role of Principal Recipient of the Global Fund grants. This marked the beginning of a new phase: transitioning from emergency response to the systematic strengthening of the country's entire TB service. 

The Foundation: Access to Treatment and the Laboratory Network (2011–2019) 

The primary challenge during the initial years of operation under UNDP management was a severe shortage of medicines. In 2011, of the 806 patients with drug-resistant forms of TB, only 505 received treatment, while the rest remained on a waiting list. UNDP swiftly reprogrammed grant funds and purchased 300 additional courses of therapy. By the end of 2012, the country secured uninterrupted access to all WHO-recommended anti-TB drugs. By 2019, treatment coverage for patients with MDR-TB reached 93%. 

MDR-TB Treatment Coverage: 63% in 2011 → 93% in 2019. 

Simultaneously, a large-scale modernization of the laboratory infrastructure took place. Between 2016 and 2024, 27 GeneXpert diagnostic machines were delivered and commissioned across the country, reducing the time required to detect drug resistance from several months to just a few hours. Coverage of rapid diagnostic methods increased from 30% in 2018 to 95% by 2025. All inpatient TB facilities were equipped with modern infection control measures. 

During this same period, financial incentive mechanisms were introduced for primary healthcare workers who monitored patient compliance with treatment regimens. The integration of TB services with HIV programs also began. The results spoke for themselves: from 2015 onward, TB mortality saw a steady decline, and the incidence rate among new cases dropped from 88.5 to 77.2 per 100,000 population between 2017 and 2019 alone. 

New Medications and a Patient-Centered Approach 

Despite expanded access to treatment, the success rate of therapies for drug-resistant TB remained stagnant at 52%, and for extensively drug-resistant TB (XDR-TB), it was below 20%. The main obstacles to success were the long duration of treatment (24 months), the severe side effects of injectable drugs, and, consequently, a high rate of treatment defaults. 

In 2017, utilizing UNDP's procurement capabilities, Kyrgyzstan received new and repurposed medications — bedaquiline and delamanid. This allowed the country to introduce short-course treatment regimens lasting 9–12 months instead of 24, all-oral (injection-free) regimens (which are particularly vital for children), and individualized treatment plans for patients with MDR- and XDR-TB. By 2019, 50% of all patients with RR/MDR-TB were receiving treatment using these new drugs. 

A Success Story: From 27% to 2% — How Case Managers Saved Lives 

Prior to 2018, one in four patients (27%) in Bishkek discontinued their treatment within the first six months. Upon feeling better, patients would independently stop taking their medication, only for the disease to return in a more severe, resistant form. 

In August 2018, with the support of UNDP and the Global Fund, a team of case managers from the National Red Crescent Society began their work. They became mentors and guides for patients: delivering medications directly to their homes, helping them manage side effects, organizing consultations with doctors, and providing legal and humanitarian aid. A key innovation was video-observed therapy (VOT): patients sent a short daily video of themselves taking their medication via WhatsApp, eliminating the need for daily, exhausting visits to the clinic. 

The Result: The default rate dropped from 27% to 2–3%. The treatment success rate for drug-resistant TB in Bishkek increased from 46% to over 79%. 

A Test of Resilience: The COVID-19 Pandemic (2020–2021) 

The COVID-19 pandemic threatened to erase the results of years of hard work. In 2020, the number of newly diagnosed TB cases temporarily fell by nearly a third: closed institutions, overloaded medical staff, and public fear of visiting clinics created a very real risk of hidden transmission. 

The response was the rapid scaling up of a familiar tool — video-observed therapy (VOT). What had been a pilot project before the pandemic became the primary mechanism for patient support within a few months. Each month, approximately 1,000 patients with drug-resistant TB received remote assistance: contactless delivery of medications to their homes, remote consultations, and psychosocial support. 

UNDP and the Global Fund mobilized emergency funding: personal protective equipment (PPE), reagents, ventilators, and oxygen equipment were brought into the country. Existing GeneXpert machines were adapted to diagnose COVID-19, significantly expanding testing capabilities during peak periods. In 2021, the TB service received a computed tomography (CT) scanner, and medical oxygen generation stations were deployed in several facilities. 

The crisis revealed the latent strength of the system: accumulated flexibility, digital tools, and trust between healthcare workers and patients allowed TB services to be preserved even amidst a global catastrophe. Most of these emergency measures — VOT, remote monitoring, and strengthened outpatient models — subsequently became permanent fixtures of standard medical practice. 

Digital Transformation and Community Engagement (2022–2026) 

Following the pandemic, the partnership reached a new level, combining technological innovation with deep attention to the social needs of patients. The key shift was moving away from a vertical disease-control model toward a holistic, person-centered approach: focusing on the individual's circumstances, rights, and potentia. 

Artificial Intelligence in Diagnostic 

Portable digital X-ray machines equipped with artificial intelligence systems (CAD/AI) were purchased for regional TB centers. The software analyzes chest X-rays in minutes, automatically identifying pathological changes in the lungs and calculating the probability of tuberculosis. This partially resolved the acute shortage of radiologists in remote, rural areas. 

The mobility of these devices opened up new avenues for screening: check-ups were conducted in schools, madrasas, local administration buildings, and even in a museum. The coverage of rapid diagnostic methods reached 95% by 2025. Digitalization became more than just a tool for efficiency; it became a way to bridge geographical and social inequalities in accessing healthcare. 

Shelters and Social Support: When Housing is a Prerequisite for Healing 

For many patients, the greatest barrier to recovery is not the disease itself, but their life circumstances: homelessness, estrangement from family, or loss of employment. In 2021, with the support of UNDP and the Global Fund, a shelter opened in Bishkek (run by the "Ganesha" Public Foundation), followed by another in Osh in 2022 (run by the "Plus Center" Public Foundation). These are more than just places to sleep; here, patients receive three meals a day, medical observation, and psychological support, alongside assistance in restoring missing identity documents, applying for social benefits, and reuniting with their families. Social workers and lawyers work hand in hand to draft individual reintegration plans. 

A Success Story: Treatment Across Thousands of Miles 

Labor migrants from the Osh region are a particularly high-risk group. Upon feeling temporary improvement, many would return to Russia to work, leaving their multi-month therapy regimens unfinished. The NGO "Plus Center," a sub-recipient of the UNDP/Global Fund project, found an unconventional solution: the patients' relatives in Kyrgyzstan collected the medications monthly and sent them abroad, while the NGO staff conducted daily video calls with the patients to monitor and verify medication intake. 

Eight patients with drug-resistant tuberculosis, aged 18 to 40, successfully completed their treatment while living thousands of miles away from home. 

Outcomes and Future Outlook 

What began in 2011 as an emergency intervention to prevent a drug deficit has evolved by 2026 into a sustainable, high-tech, and deeply humane system for tuberculosis control. The current Global Fund grant for 2024–2026 totals $27.8 million USD; it is directed toward procuring advanced medications, expanding rapid diagnostics, and supporting preventative programs. In parallel, preparations are underway for the gradual transition of all key functions to state management — ensuring that the established infrastructure and methodologies continue to function independently of international funding. 

The country's ultimate goal is to completely eliminate the TB epidemic by 2030, in line with the UN Sustainable Development Goals (SDGs). The experience of the past fifteen years has clearly shown: sustainable results are achieved when a national service, backed by a century of experience, joins forces with international partners capable of bringing funding, technology, and managerial expertise. It is this model of collaboration that is confidently leading Kyrgyzstan toward a future free of tuberculosis.