Quantifying geographic heterogeneity in TB incidence and the potential impact of geographically targeted interventions in South and North City Corporations of Dhaka, Bangladesh: A model-based study

Sourya Shrestha, Mehdi Reja, Isabella Gomes, Yeonsoo Baik, Jeffrey Pennington, Shamiul Islam, Abu Jamil Faisel, Oscar Cordon, Tapash Roy, Pedro G. Suarez, Hamidah Hussain, David Dowdy

Research output: Contribution to journalArticlepeer-review

Abstract

Background: In rapidly growing, high burden urban centers, identifying tuberculosis (TB) transmission hotspots and understanding potential impact of interventions can inform future control and prevention strategies. Methods: Using data on local demography, TB reports, and patient reporting patterns in Dhaka South City Corporation (DSCC) and Dhaka North City Corporation (DNCC), Bangladesh, between 2010 and 2017, we developed maps of TB reporting rates across wards in DSCC and DNCC and identified wards with high rates of reported TB (i.e. “hotspots”) in DSCC and DNCC. We developed ward-level transmission models and estimated the potential epidemiological impact of three TB interventions: active case finding (ACF), mass preventive therapy (PT), and a combination of ACF and PT, implemented either citywide or targeted to high-incidence hotspots. Results: There was substantial geographic heterogeneity in the estimated TB incidence in both DSCC and DNCC: incidence in the highest-incidence wards was over ten times higher than in the lowest-incidence wards in each city corporation. ACF, PT and combined ACF plus PT delivered to 10% of the population reduced TB incidence by a projected 7-9%, 13-15%, and 19-23% over five years, respectively. Targeting TB hotspots increased the projected reduction in TB incidence achieved by each intervention 1.4- to 1.8-fold. Conclusions: The geographical pattern of TB notifications suggests high levels of ongoing TB transmission in DSCC and DNCC, with substantial heterogeneity at the ward level. Interventions that reduce transmission are likely to be highly effective, and incorporating notification data at the local level can further improve intervention efficiency.

Original languageEnglish (US)
JournalUnknown Journal
DOIs
StatePublished - Oct 26 2020

Keywords

  • Bangladesh
  • Case finding
  • Epidemiology
  • Heterogeneity
  • Incidence
  • Preventive therapy
  • Transmission
  • Tuberculosis

ASJC Scopus subject areas

  • Medicine(all)

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