{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T05:21:12Z","timestamp":1772774472356,"version":"3.50.1"},"reference-count":55,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T00:00:00Z","timestamp":1733356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Implementation studies indicate that the addition of tuberculosis diagnosis and treatment services into the community health extension workers' tasks\u2014that is \u2018task\u2010shifting\u2019\u2014improved case detection and treatment outcomes in Ethiopia. Given resource and operational constraints, only a limited number of areas can be targeted by an expanded task\u2010shifting program. Therefore, we mapped the distributional disparities in tuberculosis services across regions and districts and modelled the equity pathways towards optimising national scale\u2010up of this task\u2010shifting intervention in Ethiopia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used data from various sources including District Health Information Software 2; demographic, geospatial and topographic data; and previously published implementation study findings. We developed methods to integrate these datasets and to calculate the proportion of health facilities with tuberculosis services, the district population to health centre ratio, and the proportion of district population living within 2h walking distance from a health centre. Equity and disparities were then measured in terms of: tuberculosis services coverage; health centre adequacy, that is the district population served by health centres; and spatial access adequacy, that is the district population with health centre access within a two\u2010hour walking distance. Subsequently, districts were ranked according to these measures to allow prioritisation of the health extension worker task\u2010shifting intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Tuberculosis services coverage varied from 54% in Afar region to 100% in Harari region, and health centre inadequacy ranged from 10% of districts in Benishangul\u2010Gumuz to 87% in Sidama. After spatial access adjustment, health centre inadequacy ranged from 7% of districts in Sidama to 91% in Somali; and tuberculosis services inadequacy from 7% of districts in Sidama to 97% in Afar. Task\u2010shifting implemented in inadequate districts (55% of all districts) could raise national case detection rate from 66% (currently) to 88% and treatment success rate from 93% to 99%; Benishangul\u2010Gumuz achieving the largest increase of all regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Access to effective tuberculosis services presents substantial disparities across districts in Ethiopia, due to both health system and tuberculosis\u2010specific factors. Jointly considering both types of factors would enable prioritisation of districts where health extension workers would be most impactful.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.14066","type":"journal-article","created":{"date-parts":[[2024,12,5]],"date-time":"2024-12-05T08:05:11Z","timestamp":1733385911000},"page":"31-42","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Inequalities in tuberculosis control in Ethiopia: A district\u2010level distributional modelling analysis"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9934-182X","authenticated-orcid":false,"given":"Fentabil","family":"Getnet","sequence":"first","affiliation":[{"name":"Takemi Program in International Health, Department of Global Health and Population Harvard T.H. Chan School of Public Health  Boston USA"},{"name":"National Data Management and Analytics Center for Health Ethiopian Public Health Institute  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4393-0836","authenticated-orcid":false,"given":"Tom","family":"Forzy","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population Harvard T.H. Chan School of Public Health  Boston USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9351-6935","authenticated-orcid":false,"given":"Latera","family":"Tesfaye","sequence":"additional","affiliation":[{"name":"National Data Management and Analytics Center for Health Ethiopian Public Health Institute  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Awoke","family":"Misganaw","sequence":"additional","affiliation":[{"name":"National Data Management and Analytics Center for Health Ethiopian Public Health Institute  Addis Ababa Ethiopia"},{"name":"Institute for Health Metrics and Evaluation, Department of Health Metrics Sciences University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3806-2453","authenticated-orcid":false,"given":"Solomon Tessema","family":"Memirie","sequence":"additional","affiliation":[{"name":"Addis Center for Ethics and Priority Setting, College of Health Sciences Addis Ababa University  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7053-9402","authenticated-orcid":false,"given":"Shewayiref","family":"Geremew","sequence":"additional","affiliation":[{"name":"National Data Management and Analytics Center for Health Ethiopian Public Health Institute  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5345-2858","authenticated-orcid":false,"given":"Tezera Moshago","family":"Berheto","sequence":"additional","affiliation":[{"name":"National Data Management and Analytics Center for Health Ethiopian Public Health Institute  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1338-976X","authenticated-orcid":false,"given":"Naod","family":"Wendrad","sequence":"additional","affiliation":[{"name":"Ministry of Health  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2133-3208","authenticated-orcid":false,"given":"Bantalem Yeshanew","family":"Yihun","sequence":"additional","affiliation":[{"name":"Ministry of Health  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mizan Kiros","family":"Mirutse","sequence":"additional","affiliation":[{"name":"Bergen Center for Ethics and Priority Setting University of Bergen  Bergen Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0785-1791","authenticated-orcid":false,"given":"Fasil","family":"Tsegaye","sequence":"additional","affiliation":[{"name":"Ministry of Health  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1245-8839","authenticated-orcid":false,"given":"Mesay Hailu","family":"Dangisso","sequence":"additional","affiliation":[{"name":"Ethiopian Public Health Institute  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4128-0849","authenticated-orcid":false,"given":"St\u00e9phane","family":"Verguet","sequence":"additional","affiliation":[{"name":"Department of Global Health and Population Harvard T.H. Chan School of Public Health  Boston USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/trstmh\/trv108"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmyco.2016.09.023"},{"key":"e_1_2_8_4_1","volume-title":"Global Tuberculosis Report 2021","author":"WHO","year":"2021"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-017-2321-0"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0221027"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.13.0417"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06662-3"},{"key":"e_1_2_8_9_1","unstructured":"UNFPA.Ethiopia population.2022."},{"key":"e_1_2_8_10_1","volume-title":"Population projection of Ethiopia for all regions at Wereda level from 2014\u20132017","author":"CSA","year":"2013"},{"key":"e_1_2_8_11_1","unstructured":"Primary Health Care Systems (PRIMASYS).Case study from Ethiopia. 29th EPHA Annual Conference.2018."},{"key":"e_1_2_8_12_1","unstructured":"MOH.Ethiopia National Health Accounts Report 2019\/20. Addis Ababa Ethiopia: Ministry of Health.2020."},{"key":"e_1_2_8_13_1","unstructured":"MOH.Guidelines for management of TB DR\u2010TB and leprosy in Ethiopia. Addis Ababa: Ministry of Health.2018."},{"key":"e_1_2_8_14_1","unstructured":"WorkieNW RamanaGN.The health extension program in Ethiopia.2013."},{"key":"e_1_2_8_15_1","unstructured":"MOH.An implementation manual for optimizing health extension program. Addis Ababa Ethiopia: Ministry of Health.2021."},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-020-4928-x"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-017-2133-3"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000390"},{"key":"e_1_2_8_19_1","unstructured":"MOH.Tuberculosis leprosy and other lung diseases National Strategic Plan 2023 to 2030. Addis Ababa Ethiopia: Ministry of Health.2023."},{"key":"e_1_2_8_20_1","unstructured":"MOH.Multisectoral Woreda Transformation: the 2030 Agenda for sustainable development of Ethiopia. Addis Ababa Ethiopia: Ministry of Health.2019."},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.13.04008"},{"key":"e_1_2_8_22_1","unstructured":"HISP.District Health Information Software\u20102: University of Oslo. Available from:https:\/\/dhis2.org\/. Accessed 05 Mar 2023.2023."},{"key":"e_1_2_8_23_1","volume-title":"Health data repository and research tracking system","author":"NDMC","year":"2023"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/sdata.2017.4"},{"key":"e_1_2_8_25_1","unstructured":"CSA.Central statistical agency population projections for Ethiopia 2007 to 2027. In:Commission PC editor.Addis Ababa:Central Statistical Services. p.2021."},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-020-1059-1"},{"key":"e_1_2_8_27_1","first-page":"92","volume-title":"Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies","author":"WHO","year":"2010"},{"key":"e_1_2_8_28_1","unstructured":"MOH.Health sector transformation plan II\u2010 HSTP II (2020\/21\u20132024\/25). Addis Ababa Ethiopia: Ministry of Health\u2010Ethiopia.2020."},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-424"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2021.02.107"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.16.0142"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.3390\/tropicalmed7070136"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-7052-2"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60570-0"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.3402\/gha.v8.29443"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.826800"},{"issue":"10","key":"e_1_2_8_37_1","first-page":"1238","article-title":"Global tuberculosis trends: a reflection of changes in tuberculosis control or in population health?","volume":"13","author":"Oxlade O","year":"2009","journal-title":"Int J Tuberc Lung Dis"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0223559"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2022.04.031"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.5588\/pha.13.0044"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12890-017-0551-y"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph16183391"},{"key":"e_1_2_8_43_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1260-6"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-018-0146-0"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-036892"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0227293"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.5588\/ijtld.10.0691"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1021\/acsinfecdis.4c00466"},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30433-7"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2023.2184482"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1186\/2049-9957-3-27"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jix378"},{"key":"e_1_2_8_53_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-021-01268-y"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/s1473-3099(18)30443-2"},{"key":"e_1_2_8_55_1","unstructured":"EPHI MOH WHO.Ethiopia health data quality review: system assessment and data verification 2016: Ministry of Health.2016."},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0255949"}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.14066","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T13:08:59Z","timestamp":1735909739000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tmi.14066"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,5]]},"references-count":55,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/tmi.14066"],"URL":"https:\/\/doi.org\/10.1111\/tmi.14066","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,5]]},"assertion":[{"value":"2024-12-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}