ZAMSTARZAMSTAR

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 AfricaDense 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

OutreachSchool InterventionOpen 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

Clinic7,292 40,507 18

VCT 352 3,751 9

ECF 812 10,251 8

HH 55 879 6

The ZAMSTAR TeamThe ZAMSTAR Team

Plus the London gang!