The results of a large-scale community-randomized trial presented at the 42nd World Conference on Lung Health in Lille, France today show that the Zambia-South Africa TB and AIDS Reduction (ZAMSTAR) project reduced the prevalence of tuberculosis by 22%.
The intervention lasted for three years (2006 - 2009), during which the ZAMSTAR communities (in conjunction with the district and provincial health services) received support to improve TB & HIV care and service integration, including improved and community-wide TB testing and TB & HIV counselling within communities and households to facilitate prompt diagnosis and treatment.
Taking place in 24 communities across Zambia and in the Western Cape Province of South Africa, the ZAMBART project focused on finding ways to stop the transmission of TB in communities with a high burden of both TB and HIV. A total of roughly 1m individuals were involved in the ZAMSTAR interventions at a cost of less than one US dollar per person per year.
"In the era of HIV, this is the first community-randomised trial of a public health intervention to be shown to have an impact on the epidemiology of TB at community-level," said Dr. Peter Godfrey-Faussett, one of three ZAMSTAR Principal Investigators and Professor of Infectious Diseases and International Health at London School of Hygiene and Tropical Medicine (LSHTM).
ZAMSTAR employed many individuals who lived in the trial communities and who were involved in activities such as street dramas, songs and dances to encourage people to submit sputum samples for TB testing. Around 25% of all the most infectious cases that were diagnosed in the communities were found because thanks to this intervention.
"In these communities, TB and HIV affect the entire household, so you need to involve not only the TB patient but his or her entire family. If adults are not diagnosed and treated, they can infect children" said Dr Helen Ayles, ZAMSTAR Principal Investigator and Project Coordinator for ZAMBART." In addition to the reduced prevalence rate, in the communities that received household counselling children were half as likely to become infected with TB thanks to the intervention."
"ZAMSTAR really was an amazing partnership between researchers, communities and health services and the interventions were both well-received and appreciated by the communities in which we worked," said Dr. Nulda Beyers, ZAMSTAR Principal Investigator and Director of the DTTC.
In addition, ZAMSTAR leaves a legacy of hundreds of research assistants, counsellors and clinic staff who were trained during the three-year project and who now have a greater understanding not only of TB and HIV but also of community-based research, ethics and international cooperation. The work of the ZAMSTAR study has the potential to translate into real reductions in the overall burden of TB in high-burden areas.
The ZAMSTAR study was carried out by a consortium of three institutions, Zambia AIDS Related TB (ZAMBART) Project, Desmond Tutu TB Centre (DTTC) at the Stellenbosch University and the London School of Hygiene and Tropical Medicine (LSHTM), as one of three large studies within the Consortium to Respond Effectively to the AIDS and TB Epidemics (CREATE). Funding for this $27 million study came from the Bill and Melinda Gates Foundation.
About The Consortium to Respond Effectively to the AIDS/TB Epidemic:
Funded by a grant from the Bill and Melinda Gates Foundation in 2002, CREATE – the Consortium to Respond Effectively to the AIDS/TB Epidemic - is a consortium of leading experts in TB and HIV who design novel public health interventions to reduce the burden of HIV-related TB at the population level.
The Consortium is led by the Johns Hopkins University Center for Tuberculosis Research, in Maryland, U.S.A., and includes the following partners:
Aurum Institute for Health Research - Johannesburg, South Africa
Desmond Tutu Centre at Stellenbosch University - Tygerberg, South Africa
Municipal Health Secretariat of Rio de Janeiro - Rio de Janeiro, Brazil
London School of Hygiene and Tropical Medicine - London, England
ZAMBART Project - Lusaka, Zambia
Stop TB Partnership, WHO
Led by Dr. Richard Chaisson, CREATE hopes to transform global policies for TB/HIV through evidence-based advocacy. http://www.tbhiv-create.org/
About London School of Hygiene and Tropical Medicine:
The London School of Hygiene & Tropical Medicine (LSHTM) is a renowned research-led postgraduate institution of public health and global health. Its mission is to improve health in the UK and worldwide through the pursuit of excellence in research, postgraduate teaching and advanced training in national and international public health and tropical medicine, and through informing policy and practice in these areas. Part of the University of London, the School is the largest institution of its kind in Europe with a remarkable depth and breadth of expertise encompassing many disciplines associated with public health. http://www.lshtm.ac.uk
About Desmond Tutu TB Centre:
The Desmond Tutu TB Centre is an academic research centre of the Department of Paediatrics and Child Health, Faculty of Health Sciences. It has as its mission the improvement of the health of vulnerable groups through influencing policy based on new knowledge created by research focusing on health, mainly TB and HIV. To achieve this, the Centre works closely with the South African Department of Health and the local communities. It provides training to academic and health services staff, builds capacity in the University and the Department of Health, provides service to communities and advocates for TB and health. Himself a former TB sufferer, Archbishop Desmond Tutu champions tuberculosis research and care. He is also the patron of the on-campus Tygerberg Children's Hospital. http://www.sun.ac.za/tb
About ZAMBART Project:
The Zambia AIDS Related Tuberculosis (ZAMBART) Project has conducted research into the dual TB/HIV epidemic for 20 years in Zambia. In 2004 ZAMBART established itself as a Zambian NGO from a collaboration between the University of Zambia School of Medicine and the London School of Hygiene and Tropical Medicine, and it is now based in the University of Zambia School of Medicine Campus. ZAMBART now collaborates closely with government, non-governmental and academic institutions within Zambia, Africa and the rest of the world. ZAMBART is also committed to increasing Zambian research capacity. http://www.zambart.org