Zambia and the Western Cape Province, South Africa
ZAMSTAR is a large community-randomized trial of innovative intensified case finding methods across 24 communities in Zambia and Western Cape, South Africa. The primary aim is to reduce TB prevalence by increasing access to TB diagnostics for those with symptoms, and by implementing TB and HIV household interventions.
The study involves a four-arm factorial design. All communities receive strengthened Directly Observed Therapy Short Course (DOTS) and access to clinic-based TB/HIV activities. Six communities receive community-based improved case finding of TB. Six other communities receive household level TB/HIV integrated activities, and six more communities receive both community-based improved case finding of TB and household level TB/HIV integrated activities. The remaining six communities serve as the control group. The primary outcome is decreased TB prevalence.
Improved Case Finding
Three components of improved case finding are employed at the community and health center level:
Community members are offered open access to sputum smear at health centers;
All primary schools in the community/district receive an education programme about HIV, tuberculosis and its transmission and diagnosis. Students receive tuberculin skin tests as part of the intervention, and engage their parents in TB education;
Drama groups are used to attract community members and to educate them in culturally appropriate ways about tuberculosis and its diagnosis. Symptomatic members of the public are asked to submit sputum samples on the spot. Smear positive cases are treated and followed up by the existing health services.
Integrated TB/HIV care is also delivered through the household of persons with active TB. Household members are offered access to HIV testing, case finding for tuberculosis, preventive therapy for TB in the most at risk- HIV-positive individuals and children - and other HIV care options such as antiretroviral therapy.
Both Household and Intensified Case Finding interventions have proven to be feasible and acceptable to local communities and health systems. TB-HIV integration has proceeded rapidly in the ZAMSTAR sites. TB treatment supporters, community advisory boards and their members and health clinic staff have taken the initiative to continue some of the services, demonstrating the advantages of working with, and supplementing, the existing care health systems.
The community interventions are complete and the sites are beginning the final TB prevalence survey in all participating communities.
Below you can see abstracts and publications from the ZAMSTAR Study.