Spatial and Temporal Projections of the Prevalence of Active Tuberculosis in Cambodia

Background: Cambodia is among the 30 highest burden of Tuberculosis (TB) countries. Active TB prevalence has been estimated using nationally representative multistage sampling that represents urban, rural, and remote parts of the country, but the prevalence in non-sampled communes remains unknown. This study uses geospatial Bayesian statistics to estimate point prevalence across Cambodia, and demographic modelling that accounts for secular trends in fertility, mortality, urbanization and prevalence rates to project the future burden of active TB. Methods: A Bayesian hierarchical model was developed for the 2011 NTP survey to estimate the differential effect of age, sex and geographic stratum on active TB prevalence; these estimates were then married with high-resolution geographic information system layers to project prevalence across Cambodia. Future TB projections under alternative scenarios were then derived by interfacing these estimates with an individual-based demographic model. Findings: Strong differences in risk by age and sex, together with geographically varying population structures, yielded the first estimated prevalence map at a 1km scale. The projected number of active TB cases within the catchment area of each existing government healthcare facility was derived, together with projections to the year 2030 under two scenarios: No Future Improvement and Continual Reduction. Interpretation: Synthesis of health and geographic data allows likely disease rates to be mapped at a high resolution to facilitate resource planning, while demographic modelling allows scenarios to be projected, demonstrating the need for the acceleration of control efforts to achieve a substantive impact on the future burden of TB in Cambodia. Funding Statement: This work was funded by USIRP under the Infectious Diseases Programme at the Saw Swee Hock School of Public Health at the National University of Singapore. ARC was supported by the Singapore Population Health Improvement Centre (SPHERiC), National University Health System. The funders did not play a role in the design, conduct or analyses of the study nor in the drafting of this manuscript. Declaration of Interests: We declare no competing interests.