Extensively drug-resistant tuberculosis hotspots and sociodemographic associations in Durban, South Africa

BACKGROUND : Extensively drug-resistant tuberculosis (XDR-TB) incidence is driven by transmission of resistant strains in KwaZulu-Natal, South Africa. Data suggests cases may be spatially clustered; we therefore sought to identify hotspots and describe these communities. METHODS : We enrolled XDR-TB patients diagnosed from 2011–2014 in eThekwini. GPS coordinates for participant homes were collected and hotspots were identified based on population-adjusted XDR-TB incidence. Sociodemographic features of hotspots were characterized using census data. For a subset of participants, we mapped XDR-TB case non-home congregate locations and compared to results including only homes. RESULTS : Among 132 participants, 75 (57%) were female and 87 (66%) lived in urban or suburban locations. Fifteen of 197 census tracts were identified as XDR-TB hotspots with ≥ 95% confidence. Four spatial mapping methods identified one large hotspot in northeastern eThekwini. Hotspot communities had higher percentages of low educational attainment (12% vs 9%), higher unemployment (29.3% vs 20.4%), and lower percentage of homes with flush toilets (36.4% vs 68.9%). Mapping congregate locations, including workplaces, for 43 (33%) participants shifted case density towards Durban. CONCLUSIONS : In eThekwini, XDR-TB case homes were clustered into hotspots with more indicators of poverty than non-hotspots. Prevention efforts targeting hotspot communities and congregate settings may be effective in reducing community transmission.A grant from the US National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH): R01AI089349 (PI Gandhi) and R01AI087465 (PI Gandhi). It was also supported in part by NIH/NIAID grants: K23AI083088 (PI Brust), K23AI134182 (PI Auld), K24AI114444 (PI Gandhi), R01AI138646 (PI Gandhi), Emory CFAR P30AI050409 (PI Curran), Einstein CFAR P30AI124414 (PI Goldstein), by Einstein/Montefiore ICTR UL1 TR001073 (PI Shamoon), and by NIH/NHLBI T32 HL116271 (PI Guidot).https://www.ingentaconnect.com/content/iuatld/ijtldhj2020Medical Microbiolog