From Patterns to Projections: A Spatiotemporal Distribution of Drug-Resistant Tuberculosis in Paraná, Brazil (2012–2023)

Drug-resistant tuberculosis represents a challenge with high potential for spread. This ecological study aimed to describe the prevalence and incidence of drug-resistant tuberculosis and analyze its spatial, temporal, and spatiotemporal patterns in Paraná, Brazil, 2012-2023, and forecast trends through 2030. National surveillance data were analyzed using descriptive statistics, Mann-Kendall trend tests, Global and Local Moran's I, Kulldorff's spatial scan statistic, and Seasonal AutoRegressive Integrated Moving Average modeling. A total of 576 cases were identified, corresponding to an incidence of 5.08 per 100,000 inhabitants, with an increasing trend (<i>p</i> < 0.001). After peaking in 2019, incidence declined during the pandemic and rose in 2023. Isoniazid monoresistance was the most frequent profile. Prevalence was higher among males, young adults (15-34 years), and Asian and Black individuals. Spatial distribution showed expansion over time, with early circulation in the West. The North and Northwest exhibited an initial high incidence. Spatial and spatiotemporal analyses identified persistent high-risk clusters in these regions (<i>p</i> < 0.05). Forecasting suggests that, if current conditions persist, the incidence may continue to rise through 2030. The findings highlight the need for surveillance to ensure treatment adherence and interrupt transmission of resistant bacilli, supporting progress toward the global goal of tuberculosis elimination.