Molecular Epidemiological Information System to Support Management of Multidrug-Resistant Tuberculosis in Thailand

Objective: To support the End TB strategy with an informatics system that integrates genomic data and the geographic information system (GIS) of Mycobacterium tuberculosis (MTB) clinical isolates. The priority of the information system is to control multiple drug-resistant tuberculosis (MDR-TB).Methods: System requirements were clarified using an exploratory approach. A data value chain was applied for system prototyping. Role-based access control was adopted for system permission management. MDR-TB isolates were collected from Kanchanburi Province, Thailand, from 2013–2017. Genotyping information of the isolated MDR-TB strains was obtained from whole genome sequencing analysis. Spatiotemporal analysis using SaTScan™ version 9.6 was performed to identify significant high rate spatial MDR-TB clusters or hotspots of MDR-TB transmission.Results: The iMoji system architecture was established. The data entry modules consisted of (1) patient registration, (2) sample registration, (3) laboratory data entry and data analysis, and (4) verification and approval of the analyzed data. An integrative analysis of the MDR-TB genotype and geospatial data provided information for the MDR-TB cluster analysis. An MDR-TB transmission hotspot was identified with the log-likelihood ratio of 14.44 (P value < 0.001). Temporal analysis suggested that transmission occurred more frequently between 12/1/2014 to 2/28/2017.Conclusion: Our findings provide a proof of concept for integrating genomic data from MDR-TB and corresponding spatiotemporal information to guide public health interventions for tuberculosis control