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Assessing spatial heterogeneity of MDR-TB in a high burden country

Helen E. Jenkins, Valeriu Plesca, Anisoara Ciobanu, Valeriu Crudu, Irina Galusca, Viorel Soltan, Aliona Serbulenco, Matteo Zignol, Andrei Dadu, Masoud Dara, Ted Cohen
European Respiratory Journal 2012; DOI: 10.1183/09031936.00111812
Helen E. Jenkins
*Brigham and Females's Hospital, Boston, USA
#Harvard Medical School, Boston, USA
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  • For correspondence: jenkins.helen@gmail.com
Valeriu Plesca
¶National Centre of Health Management, Chisinau, Republic of Moldova
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Anisoara Ciobanu
¶National Centre of Health Management, Chisinau, Republic of Moldova
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Valeriu Crudu
+Center for Health Policies and Studies, Chisinau, Republic of Moldova
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Irina Galusca
¶National Centre of Health Management, Chisinau, Republic of Moldova
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Viorel Soltan
+Center for Health Policies and Studies, Chisinau, Republic of Moldova
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Aliona Serbulenco
§Ministry of Health, Chisinau, Republic of Moldova
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Matteo Zignol
fStop TB Dept, World Health Organization, Geneva, Switzerland
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Andrei Dadu
**World Health Organization, Regional Office for Europe, Copenhagen, Denmark
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Masoud Dara
**World Health Organization, Regional Office for Europe, Copenhagen, Denmark
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Ted Cohen
*Brigham and Females's Hospital, Boston, USA
##Harvard School of Public Health, Boston, USA
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Abstract

Multidrug-resistant tuberculosis (MDR-TB) is a major concern in countries of the former Soviet Union. The reported risk of resistance among TB cases in the Republic of Moldova is among the highest in the world. We aimed to produce high-resolution spatial maps of MDR-TB risk and burden in this setting.

We analysed national TB surveillance data collected between 2007 and 2010 in Moldova. High drug susceptibility testing coverage and detailed location data permitted identification of sub-regional areas of higher MDR-TB risk. We investigated whether the distribution of cases with MDR-TB risk factors could explain this observed spatial variation in MDR-TB.

3,447 MDR-TB cases were notified during this period; 24% of new and 62% of previously treated patients had MDR-TB. Nationally, the estimated annual MDR-TB incidence was 54 cases/100,000 persons and>1,000 cases/100,000 persons within penitentiaries. We identified substantial geographic variation in MDR-TB burden and hotspots of MDR-TB. Locations with a higher percentage of previously incarcerated TB cases were at greater risk of being MDR-TB hotspots.

Spatial analyses revealed striking geographic heterogeneity of MDR-TB. Methods to identify locations of high MDR-TB risk and burden should allow for better resource allocation and more appropriate targeting of studies to understand local mechanisms driving resistance.

  • Antibiotic resistance
  • geographic heterogeneity
  • mapping
  • moldova
  • spatial epidemiology
  • ERS
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Assessing spatial heterogeneity of MDR-TB in a high burden country
Helen E. Jenkins, Valeriu Plesca, Anisoara Ciobanu, Valeriu Crudu, Irina Galusca, Viorel Soltan, Aliona Serbulenco, Matteo Zignol, Andrei Dadu, Masoud Dara, Ted Cohen
European Respiratory Journal Jan 2012, erj01118-2012; DOI: 10.1183/09031936.00111812

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Assessing spatial heterogeneity of MDR-TB in a high burden country
Helen E. Jenkins, Valeriu Plesca, Anisoara Ciobanu, Valeriu Crudu, Irina Galusca, Viorel Soltan, Aliona Serbulenco, Matteo Zignol, Andrei Dadu, Masoud Dara, Ted Cohen
European Respiratory Journal Jan 2012, erj01118-2012; DOI: 10.1183/09031936.00111812
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