Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, China
Background: Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in China, with varying treatment outcomes across different regions. Understanding the spatial distribution of DR-TB treatment outcomes is crucial for targeted interventions to improve treatment success in high-bu...
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2024-12-01
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| Series: | Tropical Medicine and Infectious Disease |
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| Online Access: | https://www.mdpi.com/2414-6366/10/1/3 |
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| author | Temesgen Yihunie Akalu Archie C. A. Clements Zuhui Xu Liqiong Bai Kefyalew Addis Alene |
| author_facet | Temesgen Yihunie Akalu Archie C. A. Clements Zuhui Xu Liqiong Bai Kefyalew Addis Alene |
| author_sort | Temesgen Yihunie Akalu |
| collection | DOAJ |
| description | Background: Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in China, with varying treatment outcomes across different regions. Understanding the spatial distribution of DR-TB treatment outcomes is crucial for targeted interventions to improve treatment success in high-burden areas such as Hunan Province. This study aimed to map the spatial distribution of DR-TB treatment outcomes at a local level and identify sociodemographic and environmental factors associated with poor treatment outcomes in Hunan Province, China. Methods: A spatial analysis was conducted using DR-TB data from the Tuberculosis Control Institute of Hunan Province, covering the years 2013 to 2018. The outcome variable, the proportion of poor treatment outcomes, was defined as a composite measure of treatment failure, death, and loss to follow-up. Sociodemographic, economic, healthcare, and environmental variables were obtained from various sources, including the WorldClim database, the Malaria Atlas Project, and the Hunan Bureau of Statistics. These covariates were linked to a map of Hunan Province and DR-TB notification data using R software version 4.4.0. The spatial clustering of poor treatment outcomes was analyzed using the local Moran’s I and Getis–Ord statistics. A Bayesian logistic regression model was fitted, with the posterior parameters estimated using integrated nested Laplace approximation (INLA). Results: In total, 1381 DR-TB patients were included in the analysis. An overall upward trend in poor DR-TB treatment outcomes was observed, peaking at 14.75% in 2018. Deaths and treatment failures fluctuated over the years, with a notable increase in deaths from 2016 to 2018, while the proportion of patients lost to follow-up significantly declined from 2014 to 2018. The overall proportion of poor treatment outcomes was 9.99% (95% credible interval (CI): 8.46% to 11.70%), with substantial spatial clustering, particularly in Anxiang (50%), Anren (50%), and Chaling (42.86%) counties. The proportion of city-level indicators was significantly associated with higher proportions of poor treatment outcomes (odds ratio (OR): 1.011; 95% CRI: 1.20 December 2024 001–1.035). Conclusions: This study found a concerning increase in poor DR-TB treatment outcomes in Hunan Province, particularly in certain high-risk areas. Targeted public health interventions, including enhanced surveillance, focused healthcare initiatives, and treatment programs, are essential to improve treatment success. |
| format | Article |
| id | doaj-art-2188e161299149ad892cc7ee2f9215ef |
| institution | Kabale University |
| issn | 2414-6366 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Tropical Medicine and Infectious Disease |
| spelling | doaj-art-2188e161299149ad892cc7ee2f9215ef2025-01-24T13:51:20ZengMDPI AGTropical Medicine and Infectious Disease2414-63662024-12-01101310.3390/tropicalmed10010003Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, ChinaTemesgen Yihunie Akalu0Archie C. A. Clements1Zuhui Xu2Liqiong Bai3Kefyalew Addis Alene4School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, AustraliaGeospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, WA 6009, AustraliaXiangya School of Public Health, Central South University, Changsha 410078, ChinaTB Control Institute of Hunan Province, Changsha 410004, ChinaSchool of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA 6102, AustraliaBackground: Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in China, with varying treatment outcomes across different regions. Understanding the spatial distribution of DR-TB treatment outcomes is crucial for targeted interventions to improve treatment success in high-burden areas such as Hunan Province. This study aimed to map the spatial distribution of DR-TB treatment outcomes at a local level and identify sociodemographic and environmental factors associated with poor treatment outcomes in Hunan Province, China. Methods: A spatial analysis was conducted using DR-TB data from the Tuberculosis Control Institute of Hunan Province, covering the years 2013 to 2018. The outcome variable, the proportion of poor treatment outcomes, was defined as a composite measure of treatment failure, death, and loss to follow-up. Sociodemographic, economic, healthcare, and environmental variables were obtained from various sources, including the WorldClim database, the Malaria Atlas Project, and the Hunan Bureau of Statistics. These covariates were linked to a map of Hunan Province and DR-TB notification data using R software version 4.4.0. The spatial clustering of poor treatment outcomes was analyzed using the local Moran’s I and Getis–Ord statistics. A Bayesian logistic regression model was fitted, with the posterior parameters estimated using integrated nested Laplace approximation (INLA). Results: In total, 1381 DR-TB patients were included in the analysis. An overall upward trend in poor DR-TB treatment outcomes was observed, peaking at 14.75% in 2018. Deaths and treatment failures fluctuated over the years, with a notable increase in deaths from 2016 to 2018, while the proportion of patients lost to follow-up significantly declined from 2014 to 2018. The overall proportion of poor treatment outcomes was 9.99% (95% credible interval (CI): 8.46% to 11.70%), with substantial spatial clustering, particularly in Anxiang (50%), Anren (50%), and Chaling (42.86%) counties. The proportion of city-level indicators was significantly associated with higher proportions of poor treatment outcomes (odds ratio (OR): 1.011; 95% CRI: 1.20 December 2024 001–1.035). Conclusions: This study found a concerning increase in poor DR-TB treatment outcomes in Hunan Province, particularly in certain high-risk areas. Targeted public health interventions, including enhanced surveillance, focused healthcare initiatives, and treatment programs, are essential to improve treatment success.https://www.mdpi.com/2414-6366/10/1/3mappingdrug-resistant tuberculosisHunan province |
| spellingShingle | Temesgen Yihunie Akalu Archie C. A. Clements Zuhui Xu Liqiong Bai Kefyalew Addis Alene Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, China Tropical Medicine and Infectious Disease mapping drug-resistant tuberculosis Hunan province |
| title | Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, China |
| title_full | Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, China |
| title_fullStr | Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, China |
| title_full_unstemmed | Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, China |
| title_short | Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, China |
| title_sort | mapping drug resistant tuberculosis treatment outcomes in hunan province china |
| topic | mapping drug-resistant tuberculosis Hunan province |
| url | https://www.mdpi.com/2414-6366/10/1/3 |
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