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An intensive household counselling intervention reduces the burden of TB in ZAMSTAR study
Theo Smart, 2011-11-02 14:00:00
An intensive ‘household counselling’ intervention (involving TB contact tracing, multiple home visits, TB & HIV counselling and screening with linkages to care) reduced the prevalence of culture positive tuberculosis (TB) by 22% within randomised communities in Zambia and the Western Cape of South Africa, according to the results of ZAMSTAR, a long-awaited, large-scale trial, which were released on October 30th at the 42nd World Conference on Lung Health in Lille, France.
“In the era of HIV, this is the first community-randomised trial of a public health intervention to be shown to have an impact on the epidemiology of TB at community-level,” said Professor Peter Godfrey-Faussett of the London School of Hygiene and Tropical Medicine (LSHTM), one of three ZAMSTAR Principal Investigators.
However, another study intervention did not have a positive effect on TB prevalence. This intervention was called enhanced case finding (ECF) — but it is very important not to confuse this with intensified case finding (ICF) which involves actively screening people for TB. ECF as defined by this study involved a number of activities to make a TB diagnosis easier to access and encourage people with symptoms to seek out diagnosis, but essentially continued to be dependent on a person’s own health seeking behaviour (more below).
ZAMSTAR was a major study that took several years to run and analyse. It involved 24 communities that contained close to one million residents overall. To underscore the importance of the study, the former Archbishop Desmond Tutu sent a pre-recorded statement that the investigators played before the results were released:
“ZAMSTAR is the biggest study ever undertaken to understand the real situation with TB and HIV, trying to find ways to interrupt the transmission of TB in communities with a high burden of both TB and HIV.”
Consequently, an entire conference symposium was dedicated to discussing the results, some aspects of which were surprising. These data will probably continue to be analysed for years to come. This article will only touch on some of the key findings from the study, and subsequent articles will present further analysis, and expert opinion on the trial’s ramifications.
Source:1
