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Open Access Spatial clustering of drug-resistant tuberculosis in Hlabisa subdistrict, KwaZulu-Natal, 2011–2015

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SETTING: Incidencerates of tuberculosis (TB) in South Africa are among the highest in the world, and drug resistance is a major concern. Understanding geographic variations in disease may guide targeted interventions.

OBJECTIVE: To characterise the spatial distribution of drug-resistant TB (DR-TB) in a rural area of KwaZulu-Natal, South Africa, and to test for clustering.

DESIGN: This was a cross-sectional analysis of DR-TB patients managed at a rural district hospital from 2011 to 2015. We mapped all patients in hospital data to local areas, and then linked to a population-based demographic surveillance system to map the patients to individual homesteads. We used kernel density estimation to visualise the distribution of disease and tested for clustering using spatial scan statistics.

RESULTS: There were 489 patients with DR-TB in the subdistrict; 111 lived in the smaller demographic surveillance area. Spatial clustering analysis identified a high-risk cluster (relative risk of DR-TB inside vs. outside cluster 3.0, P < 0.001) in the south-east, a region characterised by high population density and a high prevalence of human immunodeficiency virus infection.

CONCLUSION: We have demonstrated evidence of a geographic high-risk cluster of DR-TB. This suggests that targeting interventions to spatial areas of highest risk, where transmission may be ongoing, could be effective.
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Keywords: HIV infection; disease clustering; geographic information systems

Document Type: Research Article

Affiliations: 1: Centre for Public Health Data, Institute of Health Informatics, University College London, London 2: Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK, Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Somkhele 3: Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK, Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Somkhele, School of Public Health, University of the Witwatersrand, Johannesburg 4: Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Somkhele 5: Africa Health Research Institute, School of Nursing and Public Health, University of KwaZulu-Natal, Somkhele, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Congella, South Africa

Publication date: 01 March 2018

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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