title: Geographic predictors of primary multidrug-resistant tuberculosis cases in an endemic area of Lima, Peru.
abstract: METHODS
  Peru reports among the highest multidrug-resistant tuberculosis (MDR-TB) rates in the Americas, with a growing proportion in previously untreated tuberculosis (TB) cases. The identification of clusters of primary MDR-TB compared with drug-susceptible TB (DS-TB) could help prioritize interventions.
  
  
  OBJECTIVE
  To examine the clustering of primary MDR-TB case residences and their proximity to high-risk locations in San Juan de Lurigancho District, Lima, Peru.
  
  
  METHODS
  Enrolled primary MDR-TB and primary DS-TB cases were interviewed and their primary residence was recorded using handheld Global Positioning System devices. Kuldorff's spatial scan statistic was used for cluster detection (SaTScan(TM), v. 9.1.1). Identified clusters were visualized in Quantum Geographic Information Systems software (v1.8.0). The following cluster centers were tested: a health centre with the highest TB and MDR-TB rates (Clinic X), a hospital and two prisons. Using regression analyses, we examined predictors of primary MDR-TB cases.
  
  
  RESULTS
  A statistically significant cluster of primary MDR-TB cases was identified within a 2.29 km radius around Clinic X. Proximity to Clinic X remained a significant predictor of primary MDR-TB in adjusted regression analyses.
  
  
  CONCLUSIONS
  We identified a hotspot of primary MDR-TB cases around Clinic X in a TB-endemic area. Causes of this clustering require investigation; targeted interventions for this high-risk area should be considered.
authors.affiliation: Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Shah
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: H W
authors.initials: HW
authors.lastname: Choi
authors.affiliation: Department of Geography, McGill University, Montreal, Quebec, Canada.
authors.forename: L
authors.initials: L
authors.lastname: Berrang-Ford
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: G
authors.initials: G
authors.lastname: Henostroza
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: F
authors.initials: F
authors.lastname: Krapp
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: C
authors.initials: C
authors.lastname: Zamudio
authors.affiliation: Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, USA.
authors.forename: S J
authors.initials: SJ
authors.lastname: Heymann
authors.affiliation: Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: J S
authors.initials: JS
authors.lastname: Kaufman
authors.affiliation: Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Ciampi
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: C
authors.initials: C
authors.lastname: Seas
authors.affiliation: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: E
authors.initials: E
authors.lastname: Gotuzzo
authors.affiliation: Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
authors.forename: T F
authors.initials: TF
authors.lastname: Brewer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification*; D010568:Peru / Q000453:epidemiology; D012044:Regression Analysis; D018088:Tuberculosis, Multidrug-Resistant / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult