The Center’s Christine Lubinski and Rabita Aziz describe visits to ZAMSTAR’s TB programs in Livingstone and Lusaka, Zambia, during a recent Congressional delegate trip to Africa.
Performers dressed in bright green ZAMSTAR uniforms sing louder and clap harder as a large crowd gathers around their truck. Another performer exuberantly walks around in front of the audience with a megaphone in hand, speaking in Nyanza – the predominant native language – to the audience in the slum area of Kanyama in south Lusaka, Zambia. Interspersed in his monologue are the English acronyms HIV and TB.
The goal of the day’s community sensitization performance is to educate the audience about HIV and TB and to inform them about health services offered at the Kanyama Clinic. The clinic is government operated and serves a catchment population of 130,000 in Kanyama. The Zambia-South Africa TB and AIDS Reduction (ZAMSTAR) study implements several intervention programs at this clinic, and throughout this impoverished area.
The ZAMSTAR study tests interventions that can reduce the spread of tuberculosis at the community level over seven years. The aim is to reduce TB prevalence by increasing access to diagnostics for those with symptoms, and by implementing TB and HIV household interventions. Access to diagnostics here means the community-based sputum collection points with accompanying lab facilities.
In Lusaka, ZAMSTAR promotes HIV and TB awareness and screening directly to the community through drama group performances and other community outreach mechanisms, including classroom educational sessions for children who are then encouraged to urge the adults in their lives with TB symptoms to get tested.
Community members are encouraged to visit the clinic to leave a sputum sample at a quiet outdoor spot within the clinic compound. Avoiding the wait associated with all other clinic services, community members can leave their sputum and then return for results. Those testing positive are referred to the so-called “TB corner” where nurses and community outreach workers offer free chest x-rays and initiate treatment. Outreach workers also visit the households of those testing positive for TB to encourage other household members to get screened as well.
The Kanyama clinic sees between 400 and 450 new cases of TB every month, with 20-25 patients giving sputum samples every day, of which the laboratory team examines no less than 20. The ZAMSTAR staff sees more than 200 patients per day while 1580 active TB patients are currently receiving treatment. The Kanyama clinic has an 85 percent TB cure rate. Seventy percent of patients are also infected with HIV.
The TB program currently employs half of the staff it needs, with just two Kanyama clinic nurses and two ZAMSTAR nurses providing services to hundreds of patients per day. They largely rely on volunteers who devote much of their time to helping operations and providing support to patients. Many of the volunteers were cured of TB themselves.
The ZAMSTAR workers were well received in this community setting with their high energy and brightly colored ZAMSTAR clothing. The dramatization of a husband and wife sparring about the importance of being screened for HIV and TB was well attended in this dense, very poor community.
Two hundred miles away in Livingstone, a ZAMSTAR containerized TB lab examines dozens of sputum samples every day (See one minute video below). It’s one of four similar labs placed throughout Zambia as a part of ZAMSTAR’s comprehensive TB prevalence survey.
These state-of-the-art labs are converted shipping containers, and can analyze up to 100 sputum samples per day. They are specially designed to quickly get optimal results in space- and resource-limited settings. As quick delivery of sputum samples to a central laboratory is difficult in Zambia, due to great distances and poor roads, these labs have been strategically placed in Zambian Ministry of Health sites in Lusaka, Livingstone, Kitwe and Ndola. Samples are analyzed quickly and efficiently, meaning TB patients can get on treatment more quickly. While these labs are utilized to analyze specimens that are garnered as part of the ZAMSTAR study, they will be donated to the local health ministries. This will facilitate much more rapid analysis of specimens so that individuals can more quickly be linked to TB treatment. .
Time will tell when the study results are analyzed and published, but the hope is that ZAMSTAR has demonstrated some effective, community-based interventions to reduce the incidence of TB in this endemic area through community education and mobilization, and active case-finding that identifies persons with active TB disease earlier and reduces transmission to others.