ZAMSTAR
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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!