Early versus Delayed Human Immunodeficiency Virus Diagnosis in Kazakhstan: A Narrative Review of Socio-behavioral Determinants, Self-testing, and Sexual Networks

Background: Eastern Europe and Central Asia remains one of the few global regions where human immunodeficiency virus (HIV) incidence continues to rise, with Kazakhstan experiencing persistent transmission despite expanded testing strategies. Timely HIV diagnosis is critical for reducing transmission, optimizing treatment outcomes, and strengthening public health surveillance. Objective: This narrative review synthesizes the evidence on socio-behavioral determinants influencing early versus delayed HIV diagnosis in Kazakhstan, with a focus on HIV self-testing, substance use, and sexual network characteristics. Methods: A narrative synthesis of national surveillance reports, policy documents, and peer-reviewed studies was conducted to examine epidemiological trends, diagnostic pathways, and behavioral factors associated with timing of HIV diagnosis in Kazakhstan. Results: Evidence indicates a clear shift from injection drug use–dominant transmission toward sexual transmission, alongside persistent regional and demographic heterogeneity. HIV self-testing and engagement with harm-reduction services facilitate earlier diagnosis, particularly among individuals who use alcohol or drugs. In contrast, older age, multiple sexual partnerships, marital status, and low perceived risk are consistently associated with delayed diagnosis. Early HIV infection is characterized by high viral load and preserved CD4 counts, whereas delayed diagnosis is associated with advanced immunosuppression and missed prevention opportunities. Conclusion: Distinguishing early from long-term HIV infection is essential for understanding transmission dynamics and optimizing prevention strategies in Kazakhstan. Integrated approaches that combine HIV self-testing with substance-use services and targeted outreach to populations at risk of delayed diagnosis – particularly older adults and individuals with multiple partners – are crucial for improving early case detection and advancing epidemic control in the region.