Where Do Patients Receive Tuberculosis Treatment in Indonesia? A Nationwide Spatial Analysis of Cross-Province Care, 2022–2025

Abstract Background Tuberculosis services may extend beyond administrative boundaries, yet national evidence on cross-province treatment in Indonesia remains limited. This study examined the geographical distribution of recorded cross-province care, characteristics associated with receiving treatment outside the province of residence, and spatial relationships between residential origins and treatment destinations. The aim was to identify priority provincial connections for service planning and coordination. Methods We conducted a nationwide retrospective observational analysis of records from Indonesia’s Tuberculosis Information System for 2022–2025. Residential and facility provinces were harmonised into 34 geographical units. Descriptive statistics, provincial inflow and outflow profiles, and bilateral concentration measures characterised treatment patterns. Modified Poisson regression estimated adjusted prevalence ratios (aPRs). Poisson pseudo-maximum likelihood models examined distance and adjacency across 4,488 origin–destination–year cells, incorporating origin-year and destination-year fixed effects. Sensitivity analyses assessed alternative record selections and spatial specifications. Counts represented treatment records rather than verified unique patients or documented referral journeys. Results Among 2,977,475 geographically eligible treatment records, 103,635 (3.48%) involved cross-province care. Recorded annual proportions ranged from 2.76% in 2022 to 4.00% in 2023. The five largest bilateral province pairs accounted for 50.02% of these records, led by DKI Jakarta–West Java (22.49%). Hospitals accounted for 71.7% of cross-province records and showed higher adjusted prevalence than community health centres (aPR, 3.20; 95% confidence interval [CI], 2.24–4.57). Doubling interprovincial distance was associated with smaller expected flows (count ratio, 0.36; 95% CI, 0.32–0.40). The hospital and distance associations remained consistent across sensitivity analyses, whereas adjacency estimates varied with geographical specification. Conclusion Cross-province tuberculosis care accounted for a small share of the national total but was concentrated within specific provincial relationships. These findings support prioritising coordination among provinces sharing substantial treatment activity and reporting service use by both residence and facility location. Linked longitudinal records are needed to determine whether these care arrangements influence treatment continuity and outcomes.