title: Geographical heterogeneity of multidrug-resistant tuberculosis in Georgia, January 2009 to June 2011.
abstract: In 2011, Georgia, in the Caucasus, reported that 11% of new and 32% of previously treated tuberculosis (TB) cases nationally had multidrug-resistant TB (MDR-TB). To help understand the mechanisms driving these high risks of drug-resistance and plan for targeted interventions, we identified geographical variability in the MDR-TB burden in Georgia and patient-level MDR-TB risk factors. We used routinely collected surveillance data on notified TB cases to estimate the MDR-TB incidence/100,000 people and the percentage of TB cases with MDR-TB for each of 65 districts and regression modelling to identify patient-level MDR-TB risk factors. 1,795 MDR-TB cases were reported (January 2009–June 2011); the nationwide notified MDR-TB incidence was 16.2/100,000 but far higher (837/100,000) in the penitentiary system. We found substantial geographical heterogeneity between districts in the average annual MDR-TB incidence/100,000 (range: 0.0–5.0 among new and 0.0–18.9 among previously treated TB cases) and the percentage of TB cases with MDR-TB (range: 0.0%–33.3% among new and 0.0%–75.0% among previously treated TB cases). Among treatment-naïve individuals, those in cities had greater MDR-TB risk than those in rural areas (increased odds: 43%; 95% confidence interval: 20%–72%). These results suggest that interventions for interrupting MDR-TB transmission are urgently needed in prisons and urban areas.
authors.affiliation: Brigham and Women s Hospital, Boston, USA.
authors.forename: H E
authors.initials: HE
authors.lastname: Jenkins
authors.forename: M
authors.initials: M
authors.lastname: Gegia
authors.forename: J
authors.initials: J
authors.lastname: Furin
authors.forename: I
authors.initials: I
authors.lastname: Kalandadze
authors.forename: U
authors.initials: U
authors.lastname: Nanava
authors.forename: T
authors.initials: T
authors.lastname: Chakhaia
authors.forename: T
authors.initials: T
authors.lastname: Cohen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D062665:Epidemiological Monitoring; D005843:Geography; D005846:Georgia (Republic) / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents