Mapping facility-based tuberculosis preventive treatment provision in Ethiopia: a geospatial analysis

Tuberculosis (TB) remains a major public health challenge in Ethiopia, despite being a preventable disease. TB preventive treatment (TPT) is a critical intervention to prevent the progression from latent TB infection to active disease, particularly among household contacts of TB patients and people living with HIV due to weakened immunity. However, the initiation and completion rates of TPT at subnational and local levels have not been thoroughly investigated. This study aims to map facility-based TPT initiation and completion rates among household contacts of TB across Ethiopia. We used national TB data from the Health Management Information System (HMIS) of the Ethiopian Ministry of Health. We included TPT initiation and completion data reported between July 2022 and June 2023. Demographic and geographic covariates were obtained from publicly available sources. In total, we used 1,132 geolocated data points for TPT initiation and 838 data points for TPT completion. Using Bayesian geostatistical analysis, we estimated TPT initiation and completion rates at a 5 × 5 km spatial resolution across Ethiopia. These high-resolution estimates were then aggregated to generate district-level estimates. A total of 208,508 contacts of index TB cases were screened for TB during the reporting period, of whom 169,890 were found negative for active TB. Among these, 31.50% were initiated on TPT. Additionally, 39,760 individuals had started TPT in the 12 months prior to the reporting period, and 87.0% of them successfully completed treatment. Both TPT initiation and treatment completion showed substantial local and subnational variations across Ethiopia. For instance, district-level TPT initiation ranged from 0.01% in Bora to 99.0% in Tiro Afeta districts of Oromia region. Distance to health facilities had a negative association with both TPT initiation (β = -0.06; 95% CrI: -0.10, -0.01) and TPT completion rate (β = -0.57; 95% CrI: -0.73, -0.42). Higher population density was negatively associated with TPT completion rate (β = -0.34; 95% CrI: -0.58, -0.10), while HIV/AIDS prevalence showed a positive association with TPT initiation (β = 0.24; 95% CrI: 0.18,0.30). Our findings revealed marked geographic variations in TPT provision at local and district levels. This suggests that districts with low performing health facilities, may require targeted interventions to optimize TPT implementation and help reduce TB burden in Ethiopia.