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ZAMSTAR

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.

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ZAMSTAR

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  1. 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

  2. Prevalence Sites Peri-urban Zambia Rural Zambia Medium South Africa Dense South Africa

  3. 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

  4. 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

  5. The communities have been randomized

  6. 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.

  7. Enhancing case-finding by removing barriers and empowering communities ECF Open Access lab School Intervention Outreach 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

  8. Several years One year ZAMSTAR Rationale Missed Diagnosed

  9. Missed Diagnosed Several years 8 months

  10. 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

  11. Yield of cases

  12. The ZAMSTAR Team Plus the London gang!

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