Inequalities in tuberculosis control in Ethiopia: A district-level distributional modelling analysis

Area of Science:

• Public Health
• Health Services Research
• Implementation Science

Background:

• Task-shifting tuberculosis (TB) diagnosis and treatment to community health extension workers (HEWs) in Ethiopia has improved outcomes.
• Resource constraints necessitate targeted scale-up, requiring an understanding of service distribution disparities.

Purpose of the Study:

• To map distributional disparities in TB services across Ethiopian regions and districts.
• To model equity pathways for optimizing the national scale-up of HEW-based TB task-shifting.

Main Methods:

• Integrated data from District Health Information Software 2, demographic, geospatial, and topographic sources.
• Calculated TB service coverage, population-to-health-center ratios, and 2-hour walking access.
• Ranked districts based on TB service coverage, health center adequacy, and spatial access adequacy for intervention prioritization.

Main Results:

• Significant regional and district-level disparities in TB service coverage and access were identified.
• Health center inadequacy ranged from 10% to 87% of districts, and spatial access inadequacy up to 97% in some regions.
• Task-shifting in inadequate districts (55% of all districts) could increase national case detection from 66% to 88% and treatment success from 93% to 99%.

Conclusions:

• Substantial disparities in access to effective TB services exist across Ethiopian districts, influenced by health system and TB-specific factors.
• Joint consideration of these factors is crucial for prioritizing districts where HEW task-shifting will be most impactful.