Decision Letters from a Kyrgyz Research Ethics Committee (2018-2022): An Empirical Review of Transparency, Rigor, and...

Research Ethics Committees (RECs) safeguard participants, yet little is known about how their decisions are communicated to study investigators in low- and middle-income countries (LMICs). We analysed 138 decision letters from a public-health REC in Kyrgyzstan (2018-2022) using descriptive statistics and documentary review. REC panel consisted predominantly of clinical and biomedical experts, with identifying data missing for 51% (n = 506/991) of panelists. Lay member participation was absent despite being mandated in SOPs. The first-review approval rate was 55.1%. Communication in decision letters tended to be prescriptive rather than advisory, with critical ethical deficiencies often not flagged. Furthermore, there was a lack of explicit citation of national or international guidance. Our observations point to opportunities to improve transparency, review quality, and stakeholder engagement through standardized templates, targeted reviewer training, and the inclusion of lay members. Strengthening these practices may enhance consistency, quality, and trust in REC decision-making in comparable post-Soviet LMICs contexts.