ZAMSTAR

24 communities in 2 countries

> 1million people

Embedded in the health systems of the 2

countries

Study end point will be prevalence surveys

after 3 years of intervention

Programmatic data will highlight the

operational challenges of implementing

TB/HIV collaborative activities

Prevalence Sites

Rural Zambia

Medium South Africa Dense South Africa

Peri-urban Zambia

Key findings confirm the ZAMSTAR

Rationale

The burden of tuberculosis is huge culture-positive prevalence of 960/100,000 in the two Zambian sites and 2,200/100,000 in the two South African sites (14,894 adults)

Many adults with a chronic cough have never sought care in their local health center, and even when they have, they have often not been offered available diagnostic tests

Study Sites

• 24 study sites have

been established

• 2 national TB

Programmes, 6

Provinces, 10

Districts, 29 clinics

and communities

have been engaged

and have bought into

study protocols

The communities have been

randomized

ZAMSTAR Enhanced Case Finding

Encourage community to seek testing ▪ Community drama

▪ School-based programme

▪ Clinic-based service

Remove barriers to sputum microscopy ▪ Open access service

▪ Within 30 minutes of home

▪ Results returned within 48 hours

Different communities respond to different approaches.

Enhancing case-finding by removing

barriers and empowering communities ECF

Outreach School Intervention Open Access lab

1. Recruit additional

microscopists

2. Develop IEC

3. Establish ECF

register

4. QA

1. Develop school

TB/HIV curriculum

2. Twice yearly

intervention in all

schools in intervention

area

3. Establish ECF

register

4. QA

1. Develop

IEC/Outreach activities

2. Weekly Outreach

activities

3. Establish ECF

register

4. QA

Diagnosed

Missed

One

year

Several

years

ZAMSTAR Rationale

Diagnosed

Missed

8 months Several years

ECF

• Community Mobilisation

– > 300 Drama

performances per year

– > 60,000 IEC materials

distributed per year

• Schools Interventions

– 70 Schools involved

• Open Access/Fast

Track sputum collection

points

0

10

20

30

40

50

60

Q3-

2006

Q4-

2006

Q1-

2007

Q2-

2007

Q3-

2007

Q4-

2007

Q1-

2008

Q2-

2008

Proportion-Zambia

Proportion SA

Proportion posZambia

Proportion pos SA

Yield of cases

Total+ Total % Yield

Clinic 7,292 40,507 18

VCT 352 3,751 9

ECF 812 10,251 8

HH 55 879 6

The ZAMSTAR Team

Plus the London

gang!