RT Journal Article
SR Electronic
T1 Assessing spatial heterogeneity of MDR-TB in a high burden country
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP erj01118-2012
DO 10.1183/09031936.00111812
A1 Helen E. Jenkins
A1 Valeriu Plesca
A1 Anisoara Ciobanu
A1 Valeriu Crudu
A1 Irina Galusca
A1 Viorel Soltan
A1 Aliona Serbulenco
A1 Matteo Zignol
A1 Andrei Dadu
A1 Masoud Dara
A1 Ted Cohen
YR 2012
UL http://erj.ersjournals.com/content/early/2012/10/25/09031936.00111812.abstract
AB 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.