Impact of Drug-Resistant Tuberculosis Prevention and Control Strategies in Southeast China: Evidence from a Longitudinal Study on Disease Epidemic Trends and Predictions Across 15 Years

Yushuo Wu,1 Mengya Li,1 Yue Zhu,2 Ying Peng,2,3 Fei Wang,2 Xinyi Chen,2,3 Zhipeng Zu,2 Bin Chen,2,3 Lin Zhou,2,3 Dingwan Chen1 1School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, People’s Republic of China; 3Zhejiang Key Laboratory of Vaccine, Infectious Disease Prevention and Control, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Lin Zhou, Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-0571-87115184, Email lzhou@cdc.zj.cn Dingwan Chen, School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, People’s Republic of China, Tel +86-0571-13857118867, Email chendw@hmc.edu.cnPurpose: Despite intensified efforts in drug-resistant tuberculosis control, the true burden and long-term trends of multidrug-resistant and rifampicin-resistant tuberculosis (MDR/RR-TB) remain unclear in many Asian settings. In China, where MDR/RR-TB accounts for a substantial share of global cases, regional variations in detection and reporting are pronounced. We aimed to examine changes in the burden and temporal trends of MDR/RR-TB in Zhejiang Province (2015– 2023) and assess the impact of existing prevention and control measures. In addition, future incidence trends were projected to 2030 using an ARIMA model.Patients and methods: Individual-level MDR/RR-TB data from the Tuberculosis Information Management System were analyzed. Cases were estimated using the World Health Organization model. Temporal trends were assessed with Joinpoint regression, and future incidence was projected to 2030 using an autoregressive integrated moving average model.Results: Among 4,950 patients included, the detection rate increased from 24· 55% in 2015 to 81· 29% in 2023. Over the same period, the estimated MDR/RR-TB burden declined substantially (average annual percentage change: − 17· 20; 95% CI − 20· 89 to − 14· 36, p< 0· 0010), whereas notified cases increased initially and declined after 2018. The gap between estimated and notification cases narrowed markedly, indicating improved surveillance sensitivity. Substantial heterogeneity was observed across regions subgroups. Projections suggest a continued decline in incidence through 2030, although uncertainty increases over time.Conclusion: Strengthened surveillance and treatment strategies in Zhejiang Province have substantially reduced MDR/RR-TB burden and improved case detection, providing regionally relevant evidence for optimizing MDR/RR-TB control strategies in similar Asian settings.Keywords: MDR/RR-TB, tuberculosis, epidemiological trends, disease burden, joinpoint