Zambia has not been spared from the TB/HIV pandemic which has been ravaging Sub-Saharan Africa for almost three decades now. Tuberculosis is the leading cause of morbidity and death among people living with HIV (PLHA) in Zambia. About 70% of PLHA are co-infected with TB and HIV.
A local NGO called ZAMBART (Zambia Aids Related TB Project), formed in 2004 from a collaboration between the University of Zambia’s School of Medicine and the London School of Hygiene and Tropical Medicine, is now working with the government, NGOs and academic institutions in Zambia, Africa and the rest of the world. It is taking the lead in TB and HIV research studies in Zambia. ZAMBART is one of the leading research groups in the world.
The Zambia-South Africa TB & AIDS Reduction (Zamstar) study is a five year study seeking to limit the spread of TB at the community level in 16 communities/sites in Zambia and eight in the Western Cape of South Africa. About 5,000 adults were targeted for the survey. The Zamstar study is funded by the Bill & Melinda Gates Foundation through the Consortium to Respond Effectively to the Aids and TB Epidemics (CREATE).
Zamstar did the following interventions at community level with the support of the district health services:
- helping TB & HIV services work together (integration of TB & HIV);
- finding more TB cases (enhanced case finding, ECF);
- delivering TB & HIV care directly to households through a TB patient (household counselling).
The ZAMSTAR study had many activities related to it. In each community team Zamstar staff members had been embedded in the district health management team and in the Ministry of Health facilities. The staff members had been implementing the Zamstar interventions as well as measuring how effective these interventions were at reducing TB. ZAMBART has also been working with Care International and Kara Counselling (partners in the Stampp-Zambart program) to ensure that the house-hold intervention is not only continued in the current communities but also rolled out in future to other communities where the two NGOs are working.
Zambia’s Ministry of Health authorised Zambart/Zamstar to pilot Isoniazid Preventiive Therapy (IPT) in all the 16 communities the study is operating in. IPT is given to individuals living with HIV but without TB to reduce their risk of developing TB.
Each Zamstar enhanced case finding site identified the following as key activities:
- ECF through community mobilization;
- stakeholder strengthening at community level through meetings with community advisory board members;
- counselling and testing for HIV among TB patients;
- drama performances promoting TB and HIV public health messages;
- providing IPT for TB prevention to HIV positive clients.
Zambart also used Tuberculin skin tests in school children in selected schools in all of its 16 communities. The study involved screening 49,855 children in 56 schools in 16 communities on assessing how many of them have become newly infected with TB in the three year study period.
The Secondary Outcomes Study (SOC) measured what happened to household members of TB patients during the course of the Zamstar study.
Zambart installed four containerized laboratories within the country to process sputum samples and conducted extensive data collection training for its field teams.
Some of the benefits of the study included:
- checking for TB, diabetes and HIV (and referred for further care if need be);
- receive health information on alcohol, cigarettes and diabetes;
- contribute information for improving health services in the future.
Dr Helen Ayles who is Zambart Project Co-ordinator had this to say about the project, “My greatest pleasure is in seeing the capacity development among the Zambart Staff.”
