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!