PopART is a five-year, $37 million, large-scale community randomized trial that will test the impact of a combination HIV prevention strategy that combines community-wide house-to-house voluntary testing for HIV, offer of medical circumcision to men who test HIV-negative, and offer of immediate initiation of antiretroviral therapy (ART) for all those testing HIV-positive. This trial will take place in 24 communities in Zambia and in the Western Cape of South Africa.
Researchers from the London School of Hygiene and Tropical Medicine (LSHTM) and partners including Imperial College London, the Zambia AIDS Related Tuberculosis Project (ZAMBART) and the Desmond Tutu TB Centre (DTTC), Stellenbosch University, South Africa will work closely on this trial with colleagues from the HIV Prevention Trials Network (HPTN). The study (designated HPTN 071) has been funded jointly by organisations including the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH), the Office of the United States Global AIDS Coordinator (OGAC) and the Bill and Melinda Gates Foundation (BMGF).
TB Reach – Wave 2 (Zambia Project for Actively Curing TB – ZAMPACT)
ZAMBART secured a TB REACH – Wave 2 grant in mid-2011. The grant will fund a new project entitled Zambia Project for Actively Curing TB (ZAMPACT) from September 2011 – August 2012 (1 year) and its focus is on improving TB control through empowering and enabling communities to participate in case-finding to detect cases of TB earlier and more effectively. The project will be implemented within the Kanyama community in Lusaka.
In addition, this community-based TB case finding approach will be combined with the use of two GeneXpert Systems. Despite the global push for a rapid roll-out of GeneXpert, developing countries are put in the position where they are unclear of how to implement this new diagnostic tool, which algorithms to follow to maximize its cost-effectiveness and how to maintain quality in diagnosis and treatment outcomes using the new system. The operational research embedded in the ZAMPACT project will provide answers to these questions so that national policy can be informed by evidence.
It is anticipated that ZAMPACT will also inform the Zambian NTP, through evidence-based implementation, of effective, affordable and feasible systems for improved TB case detection and treatment in resource-poor, urban clinics in Lusaka where the need for a new approach is vital.
In 2010, the Centre for Infectious Disease Research in Zambia (CIRDZ) collaborated with ZAMBART and the Zambian Ministries of Home Affairs and Health to establish a TB screening and diagnosis program in Lusaka Central, Livingstone and Kabwe Complex prisons. The purpose of this one-year program (called TB REACH) is to enhance TB screening practices and diagnosis within the Zambian Prison system and to determine the true prevalence and incidence of tuberculosis through intensive case finding. All prisoners, prison staff and prison volunteers will be screened for tuberculosis. Screening will also be available for at-risk members of the community surrounding the prisons. The program will screen all prisoners at entry (7,500); conduct a mass screening program of all current prisoners and staff at Lusaka Central and Kabwe Complex prisons (3,900); improve infection control by constructing isolation units to improve ventilation; and train peer educators and prison staff at the three prisons to correctly recognize TB symptoms, distribute IPT, provide pre-test HIV counselling and implement a TB literacy programme to provide educational outreach to 11,200 prisoners.
With experience from the ZAMSTAR’s enhanced case finding (ECF) intervention, ZAMBART will lead the intensive case finding to surrounding communities component of the programme (screening approximately 600 community members). ZAMBART will also use its ZamLab CTLs in Livingstone and Kabwe to process the sputum samples. This project runs until the end of 2011.
Improving Equity of Access to HIV Care and Treatment in Zambia Study
ZAMBART is part of a three-year collaborative study entitled “Improving equity of access to HIV care and treatment in Zambia”, funded by the Swiss National Science Foundation. The aim of the study is to investigate the social-cultural, socio-economic and health system-level factors influencing treatment seeking behaviour related to HIV/AIDS. The study is being conducted in four districts of Zambia: Lusaka, Mazabuka, Monze and Namwala. The other collaborating partners are the University of Zambia, Department of Social Development studies and the Swiss Tropical and Public Health Institute of the University of Basel, Switzerland. The study is expected to run from March 2009 – February 2012. The research findings will provide useful insight for both HIV policy and programme formulation and implementation in relation to increasing uptake of testing and treatment services; retention of people in HIV treatment programmes; and devising appropriate counselling strategies related to client disclosure of HIV status.
ZAMBART has extended its partnership with Delft Diagnostic Systems, Lung Institute University of Cape Town and the Image Science Institute University of Utrecht to develop a computer aided diagnostic (CAD) tool for reading chest x-rays to help diagnose tuberculosis in areas where there are health care worker, and specifically radiologist shortages. This new instalment of funding through an economic development grant from the Dutch Government is for two years (2011 – 2013) with a budget of 70,000 Euros. ZAMBART will collect digital x-rays, sputum and clinical information from 1,000 TB suspects in order to aid in the development of the CAD. In addition to the CAD, this new grant will allow for the development of e-learning materials for training of health professionals, as well as the design of a containerized digital x-ray with onsite sputum smear facilities.
Better Health Outcomes through Mentoring and Assessment (BHOMA) Study
The Better Health Outcomes through Mentoring and Assessment (BHOMA) study is being conducted from 2009-2014 using a community randomised step-wedge design trial in three districts of Zambia; Chongwe, Kafue and Luangwa districts. ZAMBART Project has partnered with the Centre for Infectious Disease Research in Zambia (CIDRZ), Ministry of Health and the Catholic Medical Mission Board (CMMB) in this ground-breaking study. ZAMBART’s role involves the evaluation of the intervention at health system, health facility and community-level. The grant was awarded in 2009 and work has thus far centred on recruiting the team and preparing the communities for randomisation. This study is being funded through the prestigious African Health Initiative of the Doris Duke Charitable Foundation.
In 2010, the Better Health Outcomes through Mentoring and Assessment (BHOMA) study survey instruments received Internal Review Board (IRB) approval and baseline data was collected for the Health Facility Survey in the three districts of operation. Orientation of the field teams to BHOMA activities was carried out between end of January and beginning of February 2011. This workshop included the formation of three field teams as well as a thorough introduction to the BHOMA study its objectives, evaluation and outcomes. The teams also discussed the best approach to working in the intervention areas and examined the evaluation tools. The teams are scheduled to undertake a field orientation exercise to meet the relevant authorities in the study communities and familiarise themselves with the areas of operation from mid-February 2011. The baseline data for the Community Survey is expected to commence in April and run until January 2012.
Quantiferon TB Gold Study
As part of the Secondary Outcome Cohort Study (SOCS) in the overall ZAMSTAR study, ZAMBART used Quantiferon TB Gold for the detection of TB infection in household members. This is a relatively new test that measures the immune systems response to M.Tuberculosis. Because it is a new test, it has not been used extensively in field settings (such as the ZAMSTAR field sites) and there are specific questions that are unanswered about its use. ZAMBART used Quantiferon tests to determine whether the test results can predict which individuals are likely to get TB disease, to evaluate Ouantiferon use in a resource limited setting and to compare Quantiferon with TST testing. This study is in its final phase and ends in late 2011.
PREVIOUS RESEARCH (2004 – 2010)
The Zambia-South Africa TB and AIDS Reduction (ZAMSTAR) study was a seven year, $27 million study, which souht to test interventions that can limit the spread of TB at the community-level. The ZAMSTAR study received funding from the Bill and Melinda Gates foundation through the Consortium to Respond Effectively to the AIDS/TB Epidemics (CREATE) and was a community randomised trial in 24 communities – 16 communities in Zambia and 8 in the Western Cape of South Africa. For three years (2006 – 2009), ZAMSTAR did one or two or sometimes three of the following interventions (activities) at community level with the support of the district health services:
- Helping TB and HIV services work together (integration of TB and HIV)
- Finding more TB cases (Enhanced Case Finding)
- Delivering TB and HIV care directly to households through a TB patient (Household Counselling)
The ZAMSTAR study had many activities related to it. In each community teams of ZAMSTAR staff members were embedded within the district health management team and in the Ministry of Health facilities. These staff members implemented the ZAMSTAR interventions as well as measured how effective these interventions were at reducing TB.
Strengthening TB, AIDS and Malaria Prevention Programmes (STAMPP)
The Strengthening TB, AIDS and Malaria Prevention Programmes (STAMPP) is a European Union funded study at ZAMBART running congruently in the ZAMSTAR study sites. Its aim is to strengthen the existing prevention, treatment and care strategies of TB and HIV at the community level. The study covers six provinces in Zambia only, these include: Central, Copperbelt, Eastern, Luapula, Lusaka and Southern.
The project consists of targeting 900,000 members of resource-poor/vulnerable households through community mobilization, social marketing, research and practices such as good nutrition, psychosocial support, and the avoidance of infections like HIV, TB, malaria and STIs to increase human resource capacity against these epidemics. Working with government institutions, health professionals and identified community members, STAMPP is a five-year project with 1.6 million Euros in funding (total budget for ZAMBART) implemented in Zambia through a partnership of three NGOs.
Click here for more information on STAMPP.
Running from 2007 through 2011, ZAMBART’s Anti-Stigma Education programme had a fruitful 2009. As a result, there are currently 27 anti-stigma Trainers of Trainers (TOT) and 249 anti-stigma facilitators trained in ZAMSTAR sites both through the STAMPP-ZAMBART programme. The Anti-Stigma Education programme has also broadcast features on radio programmes, held mini workshops with community leaders, church groups, traditional leaders, youth groups, health workers and workplaces as well as focus group discussions and quiz shows on TB and stigma. Country-wide, 18,066 people have been reached during ZAMBART TB Anti-Stigma sensitization activities.
National Drug Resistance Survey
This one-year study coordinated by ZAMBART, with participation from the Zambian Chest Disease Laboratory, sought to gauge the prevalence of multi-drug resistant (MDR) TB in the country. This survey was conducted as a requirement of the World Health Organization (W.H.O.) for all countries to submit data on MDR TB prevalence within the country. The first survey of this kind was conducted in 2000 and last year’s survey was a follow up. For the survey, the team collected 20 – 40 samples (depending on the site) from nine provinces in 47 sites throughout the country. Once collected, the samples were analyzed using several different lab tests at the National Reference Laboratory in Lusaka. The W.H.O. required amounts of samples were collected at the end of August 2009. The results of this survey can be found here.
W.H.O. Specimen Bank Study
The W.H.O. specimen bank study is a one-year study that focuses on the collection of 300 TB suspects clinical samples (sputum and serum) and sent to a W.H.O. specimen bank in France for use by researchers to devise and test out new diagnostic tools to treat TB. The study is set to begin in early 2010; however, all the groundwork for the study was put in place in 2009. The W.H.O. specimen bank study will be linked to the CAD4TB study and will take place at Kanyama Clinic in Lusaka.
Evidence for Action (EFA)
Evidence for Action (EFA) was a five-year international research programme with core funding from DfID. The EFA consortium focused on HIV treatment and care systems. The goal of the research programme was to contribute to knowledge on how to design, manage and deliver comprehensive HIV treatment and care programmes in resource poor settings. The partners to this consortium are leaders in research into HIV care for children and adults, and systems of delivery. They also include experts in policy and advocacy work, and civil society strengthening. Bringing these institutions together will deliver research solutions that can be translated into policy and actions rapidly and on a large scale in developing countries. ZAMBART was one of seven partners involved in the consortium.
Team for Applied Research Generating Effective Tools and Strategies (TARGETS)
The Team for Applied Research Generating Effective Tools and Strategies (TARGETS) for Communicable Disease Control Consortium was a five-year research programme funded by DfID. Its purpose was to develop new knowledge and tools that lead to better health for the poor and vulnerable through more effective communicable disease control, focusing on the world’s “killer diseases” such as malaria, TB and HIV/AIDS. ZAMBART was one of seven partners involved in this Consortium.