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Study Design: This is a historical cohort study. Methods: A time-dependent method was used to estimate Rt , and monthly data from the national TB registry were scrutinized from 2011 to 2021. Results: A decline was observed in SPPTB incidence rates of 50909 SPPTB cases in Iran from 2011 to 2021. Approximately 29.1% of the cases were diagnosed within a month, while 44.5% experienced a one to three-month delay in diagnosis. The analysis revealed substantial heterogeneity in TB transmission dynamics across various provinces of Iran. Provinces such as Sistan and Baluchestan, Golestan, Guilan, Khuzestan, Tehran, and Khorasan Razavi exhibited the highest effective reproduction numbers. Additionally, there was a decreasing trend in the effective reproduction numbers across all provinces from 2011 to 2020. Conclusion: Effective reproduction numbers declined in most provinces from 2011 to 2020 but increased moderately after the COVID-19 pandemic, highlighting the need for targeted public health interventions. Although SPPTB incidence rates are declining nationally, elevated incidence rates and effective reproduction numbers in regions such as Sistan and Baluchestan, Golestan, Guilan, Khuzestan, Tehran, and Khorasan Razavi signify the need for persistent TB management efforts in Iran.<\/jats:p>","DOI":"10.34172\/jrhs.2024.168","type":"journal-article","created":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T04:50:58Z","timestamp":1727844658000},"page":"e00633","update-policy":"https:\/\/doi.org\/10.34172\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effective Reproduction Number of Smear-Positive Pulmonary Tuberculosis in Iran: A Registry-Based Study (2011-2021)"],"prefix":"10.34172","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3853-0977","authenticated-orcid":true,"given":"Maryam","family":"Rastegar","sequence":"first","affiliation":[{"name":"Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"Student Research Committee, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6873-0064","authenticated-orcid":true,"given":"Vahid","family":"Fakoor","sequence":"additional","affiliation":[{"name":"Department of Statistics, Ferdowsi University of Mashhad, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eisa","family":"Nazar","sequence":"additional","affiliation":[{"name":"Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahshid","family":"Nasehi","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran"},{"name":"Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saeed","family":"Sharafi","sequence":"additional","affiliation":[{"name":"Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8287-9594","authenticated-orcid":true,"given":"Mohammad Taghi","family":"Shakeri","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran"},{"name":"Social Determinant of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"20123","published-online":{"date-parts":[[2024,7,30]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1016\/s2666-5247(22)00359-7"},{"key":"R2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004252"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1101\/cshperspect.a017863"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.01727-2020"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1186\/s12929-020-00667-6"},{"key":"R6","doi-asserted-by":"crossref","unstructured":"Mehra C. 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