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Home / The International Journal of Tuberculosis and Lung Disease, Volume 18, Number 11

Geographic predictors of primary multidrug-resistant tuberculosis cases in an endemic area of Lima, Peru

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SETTING: Peru reports among the highest multidrug-resistant tuberculosis (MDR-TB) rates in the Americas, with a growing proportion in previously untreated tuberculosis (TB) cases. The identification of clusters of primary MDR-TB compared with drug-susceptible TB (DS-TB) could help prioritize interventions.

OBJECTIVE: To examine the clustering of primary MDR-TB case residences and their proximity to high-risk locations in San Juan de Lurigancho District, Lima, Peru.

DESIGN: Enrolled primary MDR-TB and primary DS-TB cases were interviewed and their primary residence was recorded using handheld Global Positioning System devices. Kuldorff's spatial scan statistic was used for cluster detection (SaTScanTM, v. 9.1.1). Identified clusters were visualized in Quantum Geographic Information Systems software (v1.8.0). The following cluster centers were tested: a health centre with the highest TB and MDR-TB rates (Clinic X), a hospital and two prisons. Using regression analyses, we examined predictors of primary MDR-TB cases.

RESULTS: A statistically significant cluster of primary MDR-TB cases was identified within a 2.29 km radius around Clinic X. Proximity to Clinic X remained a significant predictor of primary MDR-TB in adjusted regression analyses.

CONCLUSION: We identified a hotspot of primary MDR-TB cases around Clinic X in a TB-endemic area. Causes of this clustering require investigation; targeted interventions for this high-risk area should be considered.

Keywords: clusters; high risk; hotspot; spatial; urban

Document Type: Research Article

Affiliations: 1: Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada 2: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 3: Department of Geography, McGill University, Montreal, Quebec, Canada 4: Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA 5: Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru 6: Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, USA 7: Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA

Publication date: 01 November 2014

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  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

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