Mapping Drug-Resistant Tuberculosis Treatment Outcomes in Hunan Province, China

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.

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).

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).

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.