Local progress towards achieving the End TB targets in Ethiopia: a geospatial analysis

Background Country-level estimates can mask local geographic variations in progress toward achieving World Health Organization's End TB targets. This study aimed to identify spatial variations in progress toward achieving the TB incidence reduction target at a district level in Ethiopia. Methods A Bayesian linear regression model with a conditional autoregressive prior structure was developed to identify drivers of spatial variations in TB incidence reduction across districts and to identify spatial patterns and variations in TB incidence reduction across Ethiopia from 2015 to 2020. Results The national average TB incidence reduction was 31%. Ten out of 14 regions achieved a reduction of >20% in TB incidence. Out of 641 districts, 395 (61.6%) met the 20% reduction target, predominantly in the Oromia, Amhara, and South Ethiopia regions. Spatial clustering of decreased incidence reduction was noted in the Afar, Benishangul-Gumuz, and Somali regions. Factors associated with the percentage reduction in TB incidence include a 1% increase in the proportion of individuals with good TB knowledge [β: 4.23%; 95% credible interval (CrI): 1.6, 6.9], a 1-unit increase in the TB service readiness index (β: 3.41%; 95% CrI: 0.89, 6.1), and a 1-km increase in the distance from the international border (β: 2.63%; 95% CrI: 0.02, 5.10). Conclusion Geographic disparities in TB incidence reduction persist in Ethiopia, with only some districts achieving the national reduction targets. Targeted interventions, such as improving TB service readiness and enhancing awareness through education, are crucial to addressing these gaps, particularly in regions such as Afar, Benishangul-Gumuz, and Somali.