Community counseling reduced the prevalence of TB

Issue: January 2012

The Zambia-South Africa Tuberculosis and AIDS Reduction project reduced the prevalence of tuberculosis by 22%, according to results presented at the 42nd Union World Conference on Lung Health in Lille, France.

The large-scale community-randomized trial was conducted from 2006 to 2009, in which the Zambia-South Africa TB and AIDS Reduction (ZAMSTAR) communities received support to improve TB and HIV care and service integration, which included improved and community-wide TB testing and TB and HIV counseling to facilitate prompt diagnosis and treatment.

The study was conducted in 24 communities in Zambia and the Western Cape province of South Africa, and approximately 1 million people were involved in the interventions at a cost of less than $1 per person per year.

ZAMSTAR employed many 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. About 25% of all of the most infectious cases that were diagnosed in the communities were found through these interventions.

“In the era of HIV, this is the first community-randomized trial of a public health intervention to be shown to have an impact on the epidemiology of TB at community-level,” Peter Godfrey-Faussett, BA, MBBS, one of three ZAMSTAR principal investigators and professor of infectious diseases and international health at the London School of Hygiene and Tropical Medicine, said in a press release.

“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,” Helen Ayles, PhD, ZAMSTAR principal investigator, said in a press release. “In addition to the reduced prevalence rate, in the communities that received household counseling, children were half as likely to become infected with TB, thanks to the intervention.”

The ZAMSTAR study was funded through a consortium of three institutions led by Johns Hopkins University Center for Tuberculosis Research — 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 & Melinda Gates Foundation.

For more information on the consortium, go to www.tbhiv-create.org.

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