Background and Aim: Despite progress in HIV prevention and treatment in many regions, Eastern Europe and Central Asia continue to experience a rising epidemic, with a 20% increase in new HIV cases since 2010. Pediatric HIV remains a significant concern, with 13,000 children (0–14 years) living with HIV in Eastern Europe and Central Asia. Mother-to-child transmission (MTCT) rates in the region stand at 10%, far exceeding the global elimination targets of 2% (for non-breastfeeding mothers) and 5% (for breastfeeding mothers). However, country-specific, age-disaggregated data on pediatric HIV (prevalence, incidence, mortality, and ART coverage) remain scarce, hindering targeted interventions. This study aimed to assess the prevalence, incidence, and mortality of HIV among children under 5 years in Central Asia and evaluate health expenditures related to pediatric HIV treatment in the region. Methods: This descriptive study includes prevalence, incidence of HIV, and all deaths of children under 5 years of age living with HIV, in different regions covered by Central Asia during the years 1990 to 2021. Information was collected from the mortality registration system. Financial data on HIV-related health spending for each country of interest were gathered through the Development Assistance to Health (DAH) database. The model framework was based on the Global Burden of Disease (GBD) protocol. Results: There is a dramatic surge in HIV prevalence across Central Asia, from 4,776 cases in 1990 to over 1.5 million in 2019. Kazakhstan and Uzbekistan faced the most significant increases, while Georgia showed progress in reducing new infections, and Mongolia remained the least affected. Male children consistently had higher rates of HIV-related incidence and mortality. Notably, Uzbekistan experienced a rise in under-5 HIV-related mortality, from 10.06 per 100,000 in 1990 to 11.52 in 2019. Disparities in healthcare spending were evident, with Kazakhstan and Kyrgyzstan demonstrating more substantial investments, in contrast to lower per capita spending in Uzbekistan and Turkmenistan. Conclusion: Overall, the Central Asian region is experiencing a surge in HIV cases among children under 5 years of age, which contrasts with global trends. This may be attributed to disparities in healthcare spending, access to care, prevention efforts, and the stigma associated with HIV in Central Asia.

The role and importance of entrepreneurship in the national economy is not controversial. As it is known, the priority is the development of small and medium-sized enterprises. Because this is, first of all, the key to the socioeconomic development of the country. So far all conditions have been created by the state, but no concrete results have been achieved. This circumstance indicates the need for research in this direction. The purpose of the research work is to assess the state of formation and development of small and medium-sized enterprises, the influence of the state support system and develop recommendations for its improvement. From the first years of independence to the present, various tools for supporting entrepreneurship have been used in our country. A number of government programs have been adopted and implemented. But the real results are low. In this direction, a study was conducted on critical analysis, systematization, and evaluation. The results of the study showed that the programs of state support for small and medium-sized enterprises adopted and implemented in the country did not have a significant positive impact on its dynamic development and improvement of indicators. Even some programs were suspended or canceled before the implementation period ended. State initiatives to develop entrepreneurship have not been completed, respectively, there have been no concrete results. Author’s conclusions and recommendations were made on this issue. All this speaks of high scientific and practical significance. The value of research work is characterized primarily by systematization, evaluation of results and the development of scientifically based recommendations and conclusions on improving state support for the development of entrepreneurship, including small and mediumsized enterprises in the country. The results of the study will have a positive effect on the development of small and medium-sized businesses, increasing the efficiency of activities. Therefore, they have not only theoretical, but also practical significance.

Considering Astana declaration on Primary healthcare (PHC) and universal healthcare coverage UN member countries agreed on committing for PHC development. Kazakhstan prepared legal basis for that during ongoing healthcare system reform. Meanwhile, there is no clear mechanism for integration of sectors to address person and community centeredness for health, which has emerged into a need of rethinking engagement between outpatient clinics and their communities. Local NGO “Community health committee” has led the bottom-up initiative in collaboration with Kazakh National Medical University, Outpatient clinic of Almaty State hospital #5, Medeo district mayor’s office and WHO European Center for PHC for creation of an integrated plan to strengthen diseases prevention and health promotion at the district. Project aims to strengthen people centeredness of PHC at Medeo district, through equal integration of all stakeholders into every step of decision-making using community based participatory research framework. Project includes development of teamwork in PHC teams’ through multi-professional training, development of nurses’ competencies for more autonomous work in community, community capacity building and empowerment. After gaining support from all stakeholders, we organized two interactive seminars with community members and PHC teams in order to assess district health needs and build an action plan. Ownership of community members in decision on priority health problem provided community buy-in, high level of engagement and enthusiasm in designing and implementation of the project activities. Voice from empowered community on priority health needs were accounted by local policymakers and led for creation of action plan on identified needs to be implemented in 2019 -2020. One of the main limits of the community engagement is gaining trust and sustainability of the group, we are mitigating it through involvement of academia as an “umbrella”. Key messages: Project will create a model for equal partnership in disease prevention and health promotion in Kazakhstan. Engaging all key stakeholders based on equal partnership creates sustainable outcomes for health and solidarity.

Nursing is Kazakhstan is undergoing a significant transformation in the scope of practice within Primary Health Care Centers of Excellence. This transformation aims to improve the delivery of primary health care services and enhance patient outcomes leading journey to achive "Health for All". Purpose. This study aims to analyze current scope of practice of Primary Health Care (PHC) nurses in Kazakhstan and their role in delivering holistic comprehensive care, as well as their engagement in community empowerment. Methods. We used cross sectional observational method to collect data from 20 PHC team nurses in Taraz city polyclinic №5 and 24 PHC team nurses in Taraz city polyclinic №2, using survey on actual scope of practice and employee empowerment scale. Results. The role of PHC nurses in care coordination and communication is vital, although there is room for improvement in collaborative care planning. Additionally, patient education and counseling are integral components of the practice, and the nursing specialists of the Centers of Best Practice PHC actively implement them, but there is a need to expand mental health counseling. Strengthening nurses' capacity for independent practice could optimize patient care within primary care settings. The MIOMOS project has had a notable impact on nurse empowerment and leadership development among PHC nurses, fostering positive change within primary healthcare settings. Conclusion. In conclusion, this study provides valuable insights into various facets of PHC nursing practice, highlighting areas of strength and opportunities for improvement. Furthermore, it emphasizes the significance of strengthening teamwork, enhancing care coordination efforts, expanding patient education initiatives, empowering nurses for independent practice, and leveraging quality improvement projects like MIOMOS to advance the delivery of high-quality primary healthcare services. Keywords: Primary healthcare nursing, empowerment, leadership, person-centered care, nurse's Scope of Practice

Background: Aim of this study is to present results and evaluate mid-term outcomes on using of three bariatric procedures - laparoscopic sleeve gastrectomy, Roux-en-Y gastric bypass, and One Anastomosis Gastric Bypass in the Kazakhstani population. According to the World Obesity Federation Kazakhstan is among countries that has high obesity rates, however there are not enough mechanisms in place to regulate it and there is still limited access to bariatric surgery. Materials and Method: This study employed retrospective design. Patients undergoing bariatric surgery at the Syzganov National Scientific Center of Surgery between January 2018 and December 2023 were consecutively recruited for the study. Result: The primary outcomes of this study were the percentages of excess weight loss and total weight loss at 1-, 3-, 6-, and 12-months post-surgery. Secondary outcomes included perioperative adverse events for each surgical group and improvement in obesity-related medical conditions. The findings demonstrate the potential of surgical interventions to address the growing burden of obesity and its metabolic consequences. Conclusion: While all procedures demonstrated efficacy, laparoscopic sleeve gastrectomy was associated with rapid reductions in BMI and excess weight loss, while Roux-en-Y gastric bypass achieved greater absolute weight loss over time. One Anastomosis Gastric Bypass offered a balanced alternative, though it showed an increased incidence of gallstone formation. The demonstrated efficacy of bariatric surgery supports its inclusion in mandatory health insurance coverage in Kazakhstan, potentially improving patient access and reducing long-term healthcare costs associated with obesity-related comorbidities.

Healthcare reform in Kazakhstan has created a basis for shift from disease centered approach to person and prevention centered healthcare. In order to embrace that agenda, Kazakh National Medical University has developed and implemented project-based course in General practitioners (GP) training program at the internship level. The objective of the program is to acquire skills on work in multidisciplinary teams for health promotion and research. We used project-based learning pedagogical framework for the course. 6 ECTS course was integrated into curriculum of internship in the track of GP training, at the 7th year, for 1 semester. During the course participants were introduced to the theoretical concepts of health promotion and disease prevention program planning, created and implemented their own project. At the end of the course students were required to do a poster presentation. Main outcomes of educational program were that students will (1) gain understanding of health promotion and disease prevention concepts, (2) would be able to implement research skills, (3) and work in integrated multidisciplinary team. To measure results, we disseminated self-administered online based questionnaire for students after the last class (n = 122). Questionnaire consisted of 4 domains: self-development and team work, teaching, context and clinical practice. There were 17 domains that students assessed with 5-point Likert scale, where 1- strongly disagree, 2- disagree, 3- agree to some extent, 4 - agree, 5 - strongly agree. Questionnaire also included 1 open - ended question for overall comments on the course and demographic questions. The response rate was 68,8% (n = 84), overall satisfaction rate was 77.6% (3.88 out of 5), rate on team work and practical work was 86% (4.3) and 83.6% (4.18). Comments of students showed that there is still not enough understanding on integrated person-centered primary healthcare approach and lack of integrated team work at clinical sites. Key messages: Education of future general practitioners should include training on teamwork in integrated teams and health promotion. Project based learning helps training multi-disciplinary team work skills not only within students but also in teams at involved sites.