Peterson, Meaghan L.Gandhi, Neel R.Clennon, JulieNelson, Kristin N.Morris, NatashiaIsmail, Nazir AhmedAllana, SalimCampbell, AngieBrust, James C.M.Auld, Sara C.Mathema, BarunMlisana, KolekaMoodley, PraviShah, N. Sarita2020-03-102020-03-102019-06Peterson, M.L., Gandhi, N.R., Clennon, J. et al. 2019, 'Extensively drug-resistant tuberculosis hotspots and sociodemographic associations in Durban, South Africa', International Journal of Tuberculosis and Lung Disease. vol. 23, no. 6, pp. 720–727. doi: 10.5588/ijtld.18.0575.1027-3719 (print)1815-7920 (online)10.5588/ijtld.18.0575http://hdl.handle.net/2263/73697BACKGROUND : 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.enInternational Union Against Tuberculosis and Lung DiseaseTuberculosis (TB)Extensively drug-resistant tuberculosis (XDR-TB)Activity spaceSociodemographicHotspotSouth Africa (SA)Postprint Article