Abstract Background Implementation studies indicate that the addition of tuberculosis diagnosis and treatment services into the community health extension workers' tasks—that is ‘task‐shifting’—improved 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‐shifting program. Therefore, we mapped the distributional disparities in tuberculosis services across regions and districts and modelled the equity pathways towards optimising national scale‐up of this task‐shifting intervention in Ethiopia. Methods 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‐hour walking distance. Subsequently, districts were ranked according to these measures to allow prioritisation of the health extension worker task‐shifting intervention. Results 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‐Gumuz 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‐shifting 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‐Gumuz achieving the largest increase of all regions. Conclusions Access to effective tuberculosis services presents substantial disparities across districts in Ethiopia, due to both health system and tuberculosis‐specific factors. Jointly considering both types of factors would enable prioritisation of districts where health extension workers would be most impactful.

Fentabil Getnet

Tom Forzy

Latera Tesfaye

Awoke Misganaw

Solomon Tessema Memirie

Shewayiref Geremew

Tezera Moshago Berheto

Naod Wendrad

Bantalem Yeshanew Yihun

Mizan Kiros Mirutse

Fasil Tsegaye

Mesay Hailu Dangisso

Stéphane Verguet

Tropical Medicine & International Health

热带医学与国际健康代表伦敦卫生和热带医学学院、瑞士热带和公共卫生研究所、热带医学和国际健康基金会、比利时热带医学研究所和伯恩哈德-诺希特热带医学研究所出版。热带医学与国际健康是欧洲热带医学与国际健康联合会 (FESTMIH) 的官方期刊。

Tropical Medicine and International Health is published by the London School of Hygiene and Tropical Medicine, the Swiss Tropical and Public Health Institute, the Foundation for Tropical Medicine and International Health, the Institute of Tropical Medicine in Belgium, and the Bernhard Nocht Institute for Tropical Medicine. It serves as the official journal of the Federation of European Societies for Tropical Medicine and International Health (FESTMIH).

《Tropical Medicine and International Health》是由伦敦卫生与热带医学学院、瑞士热带与公共卫生研究所、热带医学与国际健康基金会、比利时热带医学研究所以及伯恩哈德-诺希特热带医学研究所共同出版的期刊。该期刊是欧洲热带医学与国际健康联合会（FESTMIH）的官方期刊。

Tropical Medicine and International Health

Inequalities in tuberculosis control in Ethiopia: A district‐level distributional modelling analysis

埃塞俄比亚结核病控制中的不平等现象：一项基于地区层面的分布建模分析

Category	Quartile
医学	4
医学, 热带医学	3
医学, 公共卫生、环境卫生与职业卫生	4

Inequalities in tuberculosis control in Ethiopia: A district‐level distributional modelling analysis

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Journal Info

Category	Quartile
TROPICAL MEDICINE	2