The results of a seven-year-long study into TB in the Western Cape and Zambia could chart a new way forward on how to control the pandemic.
The seven-year-long Zambia-South Africa TB and Aids Reduction (ZAMSTAR) study showed that TB was significantly reduced in communities when household counsellors made regular visits to homes of TB patients to screen all other household members for TB and tell them about how to prevent and treat it.
The trial, which was carried out in 24 communities across Zambia and the Western Cape was the biggest study ever undertaken to understand the real situation with TB and HIV beyond the clinic.
Bill Gates, and his wife, Melinda visit a TB patient who was part of the ZAMSTAR study in 2006. The Bill and Melinda Gates Foundation helped to fund the ZAMSTAR project. PHOTO: Damien Schumann
It showed that its household counselling intervention reduced the prevalence of culture positive tuberculosis in these communitiesby 22% compared to the communities that weren't visited.
Children living in the communities that were involved in the household counselling were half as likely to become infected with TB.
"The good news is that we've now got evidence of what works for TB control," said the Deputy Director General of the National Department of Health, Yogan Pillay, at the release of the results at the 42ndWorld Conference on Lung Health in Lille, France, on Sunday.
9 000 household visits
ZAMSTAR teams went to 9 000 households in the Western Cape and Zambia. They visited each home three times, screened family members for TB as well as HIV and encouraged people to discuss their worries about TB and HIV.
The study also showed that the prevalence of TB in the eight communities in and around Cape Town in which the study was conducted, was four times as high as in the Zambian communities.
"These figures are extremely worrying. It means that around one person in every three minibus taxis has TB in the Western Cape. We cannot allow this to continue. As researchers, we have a moral obligation to ensure that our findings lead to better health care for vulnerable people," said Nulda Beyers, the director of the Desmond Tutu TB Centre at Stellenbosch University.
About a million people in 24 communities in the Western Cape and Zambia were touched by the study. It was carried out by the Desmond Tutu TB Centre, Stellenbosch University, the Zambia AIDS Related TB (ZAMBART) Project and the London School of Hygiene and Tropical Medicine.
TB still a devistating disease
Despite the increased investments in TB control over the past decade, ZAMSTAR shows that TB is still "a devastating disease for far too many people and their families," the study leaders said in a statement.
Pillay said the research was very encouraging and showed that the department was taking the right direction in its initiative to train 40 000 community health workers to visit homes and treat TB and HIV within South African communities.
"We have a very high TB burden and need to do something dramatic about it. We would be very interested to see if we can generalise the ZAMSTAR methods to see if we can do something at population level."
'Pull together to fight TB': Tutu
In a recorded message for the ZAMSTAR results launch, Archbishop Desmond Tutu said South Africans should pull together to fight TB.
"Something must be done to prevent our children from being infected – they are after all the future. We need to improve and strengthen our health services, we need better methods to diagnose TB in the clinics and we need people affected by TB, usually in poor communities, to say that they are tired of TB and that they will, just like in the apartheid years in South Africa, stand together and demand that things change."
Information by Kim Cloete on behalf of the Desmond Tutu TB Centre