Subnational tuberculosis burden estimation for Pakistan

Area of Science:

• Epidemiology
• Public Health
• Infectious Disease Modeling

Background:

• Global tuberculosis (TB) burden estimates are typically national, masking critical subnational variations.
• Subnational TB data is essential for targeted policy development and resource allocation.
• Pakistan's National TB Programme (NTP) sought granular TB burden estimates for improved public health interventions.

Purpose of the Study:

• To estimate the subnational tuberculosis burden in Pakistan using a tailored tool.
• To identify districts and provinces with the highest TB incidence and lowest case detection rates.
• To inform targeted TB prevention and care strategies at a granular level.

Main Methods:

• The SUBnational Burden Estimation for TB (SUBsET) tool was adapted for Pakistan's district-level structure.
• Districts were weighted based on population, urbanization, housing, and food insecurity.
• National TB incidence data was allocated and refined using survey and notification data for 150 districts.

Main Results:

• Estimated TB incidence varied widely across districts, from 110 to 462 per 100,000 population.
• Sindh, Khyber Pakhtunkhwa, and Punjab provinces showed the highest TB burden.
• Case detection rates (CDR) were below 70% in most districts, with over-reporting in 10 districts.

Conclusions:

• Significant heterogeneity in subnational TB incidence necessitates a granular approach in Pakistan.
• The SUBsET tool provides a transparent method for subnational TB burden estimation.
• Findings support tailored TB prevention and care strategies, improving resource allocation and public health outcomes.