The results of a seven-year-long study into TB in the Western Cape and Zambia shows how home visits by counsellors can dramatically reduce TB prevalence.
The Zambia-South Africa TB and AIDS Reduction (ZAMSTAR) 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 about TB and HIV beyond the clinic.
The trial showed that TB was significantly reduced in communities when household counselors made regular visits to homes of TB cases to screen all other household members for TB and tell them about how to prevent and treat it.
It showed that its 'household counseling' 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 counseling 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 42nd World Conference on Lung Health in Lille, France, on Sunday.
ZAMSTAR teams visited 9,000 households in the Western Cape and Zambia. They went to each home three times, screened family members for TB as well as HIV and encouraged people to discuss their concerns about TB and HIV.
"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 of Infectious Diseases and International Health at the London School of Hygiene and Tropical Medicine, Peter Godfrey-Faussett.
The study also showed that the prevalence of TB in the eight communities in andaround 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.
Despite the increased investments in TB control over the past decade, ZAMSTAR showsthat 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 decision to train 40,000 community healthworkers to visit homes and treat TB and HIV within South African communities.
"Do we need to go beyond the clinic? It's an unequivocal 'Yes.' 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 generalize the ZAMSTAR methods to see if we can do something at population level."
In a recorded message for the ZAMSTAR results launch, Archbishop Desmond Tutu said South Africans should be galvanised 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 demandthat things change."
Beyers said the results also indicated that a caring attitude towards people in the households that were visited went a long way in helping people to get diagnosed and treated for TB.
Many of the participants said they had been treated with dignity and respect during the home visits. This had encouraged them to seek treatment if they were diagnosed with TB - and to follow it through.
A participant in the study, who did not disclose her name, said the ZAMSTAR team who had visited her home, had helped her ill family.
"I have seven children who were counselled and screened for TB. They were all diagnosed with TB, but through medication they are all well now."