Identifying MDRTB transmission hotspots using routinely collected data

Manjourides, J., Lin, H.H., Shin, S., Jeffery, C., Contreras, C., Santa Cruz, J., Jave, O., Yagui, M., Asencios, L., Pagano, M. and Cohen, T., 2012. Identifying multidrug resistant tuberculosis transmission hotspots using routinely collected data. Tuberculosis, 92(3), pp.273-279.

  • Identification of MDRTB transmission hotspots in parts of the study area is crucial.
  • Resources to interrupt the transmission of resistant disease should be prioritized in these regions.
  • Further investigation, such as a molecular epidemiological study, might validate these findings and identify causes or specific high-risk locations.
  • Possible reasons for higher transmission in these areas:
    • Delayed diagnosis and treatment of infectious MDRTB patients
    • Higher population density or more respiratory contacts
    • Circulation of particularly transmissible MDR strains
  • Detecting high-risk areas suggests that geographically targeted interventions could be effective.
  • Programmatically, resources for detecting and treating MDRTB should be concentrated in these areas.

    • Abstract:

    In most countries with large drug-resistant tuberculosis epidemics, only those cases that are at the highest risk of having MDRTB receive a drug sensitivity test (DST) at the time of diagnosis. Because of this prioritized testing, identifying MDRTB transmission hotspots in communities where TB cases do not receive DST is challenging, as any observed aggregation of MDRTB may reflect systematic differences in how testing is distributed in communities. We introduce a new disease mapping method, which estimates this missing information through probability-weighted locations, to identify geographic areas of increased risk of MDRTB transmission. We apply this method to routinely collected data from two districts in Lima, Peru, over three consecutive years. This method identifies an area in the eastern part of Lima where previously untreated cases have an increased risk of MDRTB. This may indicate an area of increased transmission of drug-resistant disease, a finding that may otherwise have been missed by routine analysis of programmatic data. The risk of MDR among retreatment cases is also highest in these probable transmission hotspots, though a high level of MDR among retreatment cases is present throughout the study area. Identifying potential multidrug-resistant tuberculosis (MDRTB) transmission hotspots may allow for targeted investigation and deployment of resources.

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