Potential reasons for the decline of new HIV cases among people who inject drugs (PWID) in Kyrgyzstan.

There has been a declining trend in the number of reported cases of human immunodeficiency virus (HIV) among people who inject drugs (PWID) in Kyrgyzstan. The local HIV and public health community has suggested that this decline may be driven by interventions targeting HIV transmission among PWID, changes in drug use patterns, or possible underreporting of new HIV cases. The present study aims to examine these hypotheses using a deterministic compartmental model. Three intervention scenarios were evaluated to assess their impact on PWID population trends, HIV incidence, and case reporting. Scenario I (baseline) included needle and syringe exchange programmes, opioid substitution therapy, behavioural interventions, and pre-exposure prophylaxis, collectively referred to as preventive interventions, alongside antiretroviral therapy (ART). Scenario II excluded preventive interventions while maintaining ART. Scenario III excluded both preventive interventions and ART. The model results suggest that the decline in PWID may be a key factor contributing to the reduction of the HIV epidemic in this group. While preventive interventions and ART are unlikely to have been the primary drivers of HIV incidence trends, they appear to have played a meaningful role in reducing the overall HIV burden. Furthermore, the model indicates that observed trends in reported HIV incidence are likely to reflect changes in testing behaviour rather than actual fluctuations in the number of new infections.