Using Bayesian spatial models to map and to identify geographical hotspots of multidrug-resistant tuberculosis in Portugal between 2000 and 2016

Abstract

Multidrug-resistant tuberculosis (MDR-TB) is a major threat to the eradication of tuberculosis. TB control strategies need to be adapted to the necessities of different countries and adjusted in high-risk areas. In this study, we analysed the spatial distribution of the MDR- and non-MDR-TB cases across municipalities in Continental Portugal between 2000 and 2016. We used Bayesian spatial models to estimate age-standardized notification rates and standardized notification ratios in each area, and to delimitate high- and low-risk areas, those whose standardized notification ratio is significantly above or below the country’s average, respectively. The spatial distribution of MDR- and non-MDR-TB was not homogeneous across the country. Age-standardized notification rates of MDR-TB ranged from 0.08 to 1.20 and of non-MDR-TB ranged from 7.73 to 83.03 notifications per 100,000 population across the municipalities. We identified 36 high-risk areas for non-MDR-TB and 8 high-risk areas for MDR-TB, which were simultaneously high-risk areas for non-MDR-TB. We found a moderate correlation (ρ = 0.653; 95% CI 0.457–0.728) between MDR- and non-MDR-TB standardized notification ratios. We found heterogeneity in the spatial distribution of MDR-TB across municipalities and we identified priority areas for intervention against TB. We recommend including geographical criteria in the application of molecular drug resistance to provide early MDR-TB diagnosis, in high-risk areas.

Evaluation of drug-resistant tuberculosis treatment outcome in Portugal, 2000–2016

“…One of the strengths of this study is that it evaluated treatment outcomes of a cohort of drug-resistant TB patients over a significant amount of time. These patients were also previously characterised for the genetics of the pathogen [ 31 ] and for their spatial distribution in Portugal [ 32 ]. The knowledge about risk factors for death generated in this study will improve patients’ clinical management, enhancing treatment success, which is another strength.…”

Spatial Distribution of Drug-Resistant Tuberculosisin Makassar City, South Sulawesi Province, Indonesia

“…MDR-TB incidence and transmission are sitespecific and often different from those in non-MDR-TB settings. (Alene et al, 2017;Lin et al, 2012) Therefore, the need for specific control and prevention planning for MDR-TB and non-MDR-TB is a top priority and includes geographic criteria in the control of MDR-TB (Oliveira et al, 2022;Oliveira et al, 2020).…”

Similaridades e diferenças no tratamento de tuberculose multidroga resistente no Rio de Janeiro e Lisboa na perspectiva dos profissionais de saúde

“…Além disso, ser estrangeiro esteve associado 3 vezes mais ao insucesso e 4 vezes mais ao abandono do tratamento (Bhering et al, 2019a). Outro estudo observou que, em Portugal, casos TB-MDR eram mais propensos de terem nascido em outros países que os casos de TB não MDR (27,3% vs. 13,6%) (Oliveira et al, 2020). A dificuldade de entender como ter designado um médico de família e a incerteza sobre os direitos para acessar cuidados médicos são as principais dificuldades apontadas pelos imigrantes no acesso aos serviços de saúde (Linhas et al, 2019).…”