Ballestero JGA et al. (2025), Spatial clusters of risk and cartography of car...

ECB-ART-54101

Rev Saude Publica 2025 Jun 30;59:e11. doi: 10.11606/s1518-8787.2025059006489.

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Spatial clusters of risk and cartography of care for drug-resistant tuberculosis.

Ballestero JGA , Silva Júnior JNB , Arroyo LH , Pelissari DM , Rigolin IZ , Palha PF , Monroe AA , Ferreira QR , Leal GDC , Teixeira LO , Costa YBD , Pinto IC , Andrade RLP , Arcêncio RA .

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OBJECTIVE: To identify spatial clusters of risk and map the care network for people with drug-resistant tuberculosis in the state of São Paulo. METHODS: This is an ecological study, carried out by collecting data from the Special Tuberculosis Treatment Information System (Site-TB) of people treated for drug-resistant tuberculosis from 2013 to 2020, in the state of São Paulo. Mapping was carried out using Kernel and scan statistic techniques. RESULTS: 1,084 cases were reported in the period analyzed. São Paulo, Ribeirão Preto, Santos, Guarulhos, and Campinas were the municipalities with the highest number of cases. The spatial pattern of agglomeration of cases and referral centers for treatment were similar, with gaps in coverage in the southwest and northwest of the state. Six spatial clusters were identified: four low-risk and two high-risk, located in São Paulo, Diadema, Santos, and Guarujá. CONCLUSIONS: The concentration of cases and tertiary referral centers in metropolitan areas highlights inequalities in access to treatment for drug-resistant tuberculosis. These findings indicate the need for health policies to expand diagnosis and treatment, improving the control of drug-resistant tuberculosis in the state of São Paulo.

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	Figure 2. Kernel density estimates of geolocated drug-resistant tuberculosis cases. São Paulo, 2013 to 2020.
	Figure 3. Kernel density estimates of tertiary referral centers for drug-resistant tuberculosis treatment. São Paulo, 2013 to 2020.
	Figure 4. Distribution of clusters identified in the spatial scan analysis of drug-resistant tuberculosis cases. São Paulo, 2013 to 2020.
	Figura 1. Número de casos novos de tuberculose drogarresistente segundo o padrão de resistência inicial em São Paulo, 2013 a 2020.
	Figura 2. Estimativas de densidade de Kernel dos casos geolocalizados de tuberculose drogarresistente. São Paulo, 2013 a 2020.
	Figura 3. Estimativas de densidade de Kernel dos Centros de Referência Terciária para tratamento da tuberculose drogarresistente. São Paulo, 2013 a 2020.
	Figura 4. Distribuição dos aglomerados identificados na análise da varredura espacial dos casos de tuberculose drogarresistente. São Paulo, 2013 a 2020.