title: Assessing spatial heterogeneity of multidrug-resistant tuberculosis in a high-burden country.
abstract: Multidrug-resistant tuberculosis (MDR-TB) is a major concern in countries of the former Soviet Union. The reported risk of resistance among tuberculosis (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 subregional 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. 3447 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 per 100 000 persons and >1000 cases per 100 000 persons within penitentiaries. We identified substantial geographical 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 geographical 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.
authors.affiliation: Boston.
authors.forename: Helen E
authors.initials: HE
authors.lastname: Jenkins
authors.forename: Valeriu
authors.initials: V
authors.lastname: Plesca
authors.forename: Anisoara
authors.initials: A
authors.lastname: Ciobanu
authors.forename: Valeriu
authors.initials: V
authors.lastname: Crudu
authors.forename: Irina
authors.initials: I
authors.lastname: Galusca
authors.forename: Viorel
authors.initials: V
authors.lastname: Soltan
authors.forename: Aliona
authors.initials: A
authors.lastname: Serbulenco
authors.forename: Matteo
authors.initials: M
authors.lastname: Zignol
authors.forename: Andrei
authors.initials: A
authors.lastname: Dadu
authors.forename: Masoud
authors.initials: M
authors.lastname: Dara
authors.forename: Ted
authors.initials: T
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005843:Geography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008875:Middle Aged; D008966:Moldova / Q000453:epidemiology; D011329:Prisoners; D011634:Public Health; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents