Publication date: Jan 07, 2025

To map subnational and local prevalence of drug-resistant tuberculosis (DR-TB) across Africa. We assembled a geolocated dataset from 173 sources across 31 African countries, comprising drug susceptibility test results and covariate data from publicly available databases. We used Bayesian model-based geostatistical framework with multivariate Bayesian logistic regression model to estimate DR-TB prevalence at lower administrative levels. We estimated 148,239 DR-TB cases (95% Uncertainty Interval [UI]: 17,499- 313,683) in Africa, showing significant variation by country. Eswatini and South Africa had highest case numbers, while Algeria and Egypt had the lowest. The highest DR-TB prevalence was estimated in Eswatini (53. 26; 95%UI 13. 13-66. 12), Morocco, Tunisia, and South Africa, while the lowest prevalence was found in Gabon, the Republic of Congo, Sierra Leone, and Mali. Marked subnational variation in DR-TB prevalence was noted, where 91 subnational areas across 12 countries had prevalence rates higher than their respective national averages. Factors such as mean temperature (β=2. 01; 95% CrI: 1. 21, 3. 42), population density (β=0. 41; 95% CrI: 0. 19, 0. 95), and fine particulate matter (β=0. 66; 95% CrI: 0. 20, 0. 80) were positively associated with DR-TB prevalence. The study highlights substantial national and subnational variability in DR-TB prevalence across Africa, aiding policymakers in designing localized TB control interventions.

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Original Article