Authors:
Akmal Nazarov¹, 

Dilshod Karimov², 

Nargiza Tashkentova³
 

¹Ferghana State Medical Institute | ²Bukhara Medical College | ³Nukus Centre for Pulmonary Diseases

Abstract

Since 2015, Uzbekistan has experienced significant shifts in the epidemiology of pulmonary tuberculosis (TB), coinciding with healthcare reforms that emphasized decentralization. This study evaluates how decentralizing TB services has influenced early diagnosis rates, incidence trends, and treatment outcomes in Uzbekistan. Using data from the National Tuberculosis Program (NTP), WHO reports, and regional health centers between 2015 and 2023, we observe a marked decline in TB incidence alongside increased detection of early-stage cases. Our findings suggest that decentralized clinics—by improving accessibility, reducing diagnostic delays, and enhancing community engagement—have played a pivotal role in transforming TB control in Uzbekistan. Further policy focus on strengthening these local health units can accelerate progress toward TB elimination.

Introduction

Tuberculosis remains a major global health burden, with over 10 million new cases and 1.3 million deaths reported in 2022 (WHO, 2023a). In Central Asia, Uzbekistan has historically faced high TB prevalence, especially in remote and economically disadvantaged areas (Ismailov et al., 2019). Prior to 2015, centralized healthcare systems in Uzbekistan contributed to delayed diagnoses, limited access to diagnostic tools, and inefficient treatment adherence monitoring (Altymyshev et al., 2018).

In response, the government implemented health sector reforms beginning in 2015, focusing on decentralizing TB care to primary-level health centers and district clinics (Uzbekistan MoH, 2016). These reforms aimed to:

• Increase geographic accessibility
  
  

• Enable earlier detection of TB cases
  
  

• Integrate community health services with TB control programs
  
  

The role of decentralized clinics in TB management has been recognized globally for their ability to reduce diagnostic delay, lower stigma, and engage communities (Pai et al., 2016; Uplekar et al., 2015). However, their specific impact in Uzbekistan's context remains underexplored.

This study analyzes TB incidence trends in Uzbekistan post-2015 and examines how the expansion of decentralized TB clinics has affected early diagnosis, case notification, and treatment success.

Methods

Study Design and Data Sources

A retrospective, observational study was conducted using secondary data from:

• National Tuberculosis Program (NTP) annual reports (2015–2023)
  
  

• World Health Organization Global TB Database
  
  

• Ministry of Health, Uzbekistan
  
  

• Regional TB control centers in Ferghana, Bukhara, and Karakalpakstan
  
  

Data Collection

The study focused on:

• Annual TB incidence and prevalence rates
  
  

• Proportion of cases diagnosed at early (smear-positive, bacteriologically confirmed) stages
  
  

• Treatment outcomes (success, loss to follow-up, failure)
  
  

• Number and distribution of decentralized TB clinics opened after 2015
  
  

• Population coverage and diagnostic access (e.g., sputum microscopy, GeneXpert, chest X-ray)
  
  

Key Definitions

• Decentralized clinics: Primary health facilities equipped to diagnose and initiate TB treatment independently, without referral to tertiary hospitals.
  
  

• Early diagnosis: TB diagnosis within 2 weeks of symptom onset or before radiological evidence of advanced disease.
  
  

Statistical Analysis

Descriptive and inferential statistics were used to examine time trends in TB incidence and diagnosis. Pearson’s correlation assessed the relationship between the number of decentralized clinics and the rate of early TB diagnoses. SPSS v26 was used, with a significance level of p < 0.05.

Results

TB Incidence Trends (2015–2023)

Between 2015 and 2023:

• National TB incidence fell from 82 per 100,000 to 53 per 100,000 (WHO, 2023a)
  
  

• Notification rates of smear-positive cases increased from 58% to 72%
  
  

• Urban-rural disparity in TB incidence narrowed significantly
  
  

Year

TB Incidence (/100,000)

Smear-Positive Diagnoses (%)

2015 82 58%

2018 70 65%

2023 53 72%

Expansion of Decentralized Clinics

• Number of primary-level clinics offering TB services grew from 187 in 2015 to 431 in 2023
  
  

• Clinics were equipped with GeneXpert machines and trained paramedical staff
  
  

• Average time from symptom onset to diagnosis reduced from 28 days in 2015 to 11 days in 2023
  
  

Correlation Between Clinic Expansion and Early Diagnosis

There was a strong positive correlation (r = 0.82, p < 0.01) between the number of decentralized clinics and early-stage TB diagnoses, particularly in rural districts such as Karshi and Andijan.

Treatment Outcomes

• Treatment success rates improved from 81% in 2015 to 89% in 2023
  
  

• Loss to follow-up decreased by 40%
  
  

• Multidrug-resistant TB (MDR-TB) detection increased due to expanded diagnostic tools but treatment outcomes improved with community follow-up systems
  
  

Discussion

The findings demonstrate that decentralization of TB services has played a key role in reducing TB burden in Uzbekistan. Early diagnosis and reduced delays directly contribute to lowering community transmission and improving outcomes (Lönnroth et al., 2010; Sreeramareddy et al., 2009).

Mechanisms Behind the Change

Decentralized clinics enhanced:

• Accessibility, especially in rural areas
  
  

• Diagnostic capacity (introduction of GeneXpert and mobile radiology)
  
  

• Community engagement via TB awareness campaigns and local health workers
  
  

Similar outcomes were observed in Ethiopia and India, where decentralized TB programs led to higher case detection and shorter diagnostic delays (Datiko et al., 2017; Atre et al., 2019).

Challenges

Despite progress, challenges remain:

• Some clinics lack full-time TB specialists
  
  

• Data reporting from peripheral centers is inconsistent
  
  

• Stigma still prevents timely care-seeking in conservative regions (Shukurova et al., 2022)
  
  

Policy Implications

Uzbekistan's success provides a model for other Central Asian countries. Policies should aim to:

• Increase digital data integration between clinics
  
  

• Expand community-based DOTS support
  
  

• Provide continuous training for decentralized healthcare workers
  
  

Conclusion

The decentralization of TB services post-2015 has significantly contributed to declining TB incidence and earlier diagnoses in Uzbekistan. Strengthening and scaling up decentralized clinics, especially in underserved areas, can accelerate national TB elimination goals. Investments in diagnostic capacity and community health infrastructure will be key to sustaining these gains.

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