Health system barriers to HIV prevention among people who use drugs in Kazakhstan
Abstract
Background: Pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, yet uptake among people who use drugs (PWUD) remains low. In Kazakhstan, PrEP is delivered through centralized AIDS Centers, which may limit equitable access. This study examined health system and implementation barriers to PrEP uptake among PWUD.
Methods: We conducted 11 nominal group technique (NGT) focus groups (N = 108; 57 PWUD, 51 providers) across Kazakhstan. Participants generated and ranked barriers and facilitators to PrEP uptake (PWUD=171 votes; providers=150). Quantitative rankings were integrated with thematic analysis.
Results: Barriers reflected systemic gaps in service delivery. The most prominent barriers were lack of information (23%), stigma, fear of registration and lack of anonymity (23%), and regulatory constraints and bureaucracy (20%). Stakeholder perspectives diverged: PWUD prioritized stigma and anonymity (30%) and concerns about side effects (19%), while providers emphasized lack of awareness (31%) and patient engagement (19%). Logistical barriers such as time and distance (10%) further limited access. Facilitators highlighted feasible system adaptations, including community-based outreach and education (31%), co-location of services (19%), and improved staffing and funding (17%). Across groups, low-threshold and anonymous access was critical.
Conclusions: PrEP availability alone does not ensure access for PWUD. Centralized, facility-based delivery models are misaligned with the needs of marginalized populations. Decentralized, integrated, and low-threshold approaches—particularly through outreach and addiction services—are essential to improve equitable access. These findings provide actionable insights for health system adaptation in Kazakhstan and similar settings.
Key messages: • PrEP is effective for HIV prevention, but uptake among PWUD remains low globally.
• Multi-stakeholder evidence shows that system design—particularly stigma, bureaucracy, and lack of integration—limits access, highlighting the need for decentralized, low-threshold delivery models.
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BibTeX
@article{terlikbayeva2026health,
title = {{Health system barriers to HIV prevention among people who use drugs in Kazakhstan}},
author = {AM Terlikbayeva and YM Rozental and DO Oliveros and SA Primbetova and LM Madden and JH DeHovitz and FA Altice},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.972},
url = {https://doi.org/10.1093/eurpub/ckag169.972},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Health system barriers to HIV prevention among people who use drugs in Kazakhstan
AU - AM Terlikbayeva
AU - YM Rozental
AU - DO Oliveros
AU - SA Primbetova
AU - LM Madden
AU - JH DeHovitz
AU - FA Altice
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.972
UR - https://doi.org/10.1093/eurpub/ckag169.972
AB - Background: Pre-exposure prophylaxis (PrEP) is highly effective for HIV prevention, yet uptake among people who use drugs (PWUD) remains low. In Kazakhstan, PrEP is delivered through centralized AIDS Centers, which may limit equitable access. This study examined health system and implementation barriers to PrEP uptake among PWUD. Methods: We conducted 11 nominal group technique (NGT) focus groups (N = 108; 57 PWUD, 51 providers) across Kazakhstan. Participants generated and ranked barriers and facilitators to PrEP uptake (PWUD=171 votes; providers=150). Quantitative rankings were integrated with thematic analysis. Results: Barriers reflected systemic gaps in service delivery. The most prominent barriers were lack of information (23%), stigma, fear of registration and lack of anonymity (23%), and regulatory constraints and bureaucracy (20%). Stakeholder perspectives diverged: PWUD prioritized stigma and anonymity (30%) and concerns about side effects (19%), while providers emphasized lack of awareness (31%) and patient engagement (19%). Logistical barriers such as time and distance (10%) further limited access. Facilitators highlighted feasible system adaptations, including community-based outreach and education (31%), co-location of services (19%), and improved staffing and funding (17%). Across groups, low-threshold and anonymous access was critical. Conclusions: PrEP availability alone does not ensure access for PWUD. Centralized, facility-based delivery models are misaligned with the needs of marginalized populations. Decentralized, integrated, and low-threshold approaches—particularly through outreach and addiction services—are essential to improve equitable access. These findings provide actionable insights for health system adaptation in Kazakhstan and similar settings. Key messages: • PrEP is effective for HIV prevention, but uptake among PWUD remains low globally. • Multi-stakeholder evidence shows that system design—particularly stigma, bureaucracy, and lack of integration—limits access, highlighting the need for decentralized, low-threshold delivery models.
SN - 1101-1262
SN - 1464-360X
ER -