By: Dr Linda Mureithi (Senior Researcher at Health Systems Trust)
Dr Linda Mureithi
World Tuberculosis (TB) Day is commemorated every year on 24 March to raise awareness about TB and highlight efforts to fight to "End TB". This year's theme "Invest to End TB. Save lives." speaks to the urgency of mobilising additional resources towards achievement of global End TB targets. The COVID-19 pandemic has, unfortunately, jeopardised gains made in the fight towards these targets.
Research, in particular, is an important tool in the fight to end TB. As the WHO's Director General Dr Tedros Ghebreyesus, stated in the lead up to World TB Day: "Urgent investments are needed to develop and expand access to the most innovative services and tools to prevent, detect and treat TB."
The TREATS (Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for Active TB) Project aims to measure the success of a 'universal test and treat' project called PopART focused on reducing the prevalence and incidence of TB in 21 communities in South Africa and Zambia, whilst also raising awareness of TB and HIV through community engagement and linking anyone who tested positive for TB or HIV to immediate treatment. The project, which is funded by the European and Developing Countries Clinical Trials Partnership (EDCTP), started in November 2017 and will end in April 2022. The Health Systems Trust is the implementing partner for the TREATS project in South Africa.
TB prevalence survey mobile site
TB Prevalence Survey
As part of TREATS we conducted a TB prevalence survey (TBPS) and to recruit participants, TREATS fieldworkers went door-to-door in the communities to explain the study to community members and invite them to be tested at a nearby mobile site. A mobile site was set up at different locations in each community and included stations for symptom screening, sputum collection, blood testing and HIV testing. The mobile site included a mobile (OneStopTB™) truck with a digital X-ray machine and mobile laboratory fitted with a Gene Xpert machine for identifying TB in sputum samples. The digital X-ray machine used software called CAD4TB (computer-aided detection for TB) designed to detect TB on the digital X-rays. Each person who submitted sputum samples was asked to return the following day, when their case was reviewed by a doctor to make decisions on the potential need for referral and treatment. Approximately 50 000 participants, aged 15 years and over were enrolled in the survey across 21 communities in South Africa and Zambia.
Digital chest x-ray taken in OneStopTB mobile truck
Measuring the rate of new TB infections
Alongside the TBPS, we conducted a TB incidence study to assess the impact of the PopART intervention on the rate of new TB infections. It followed a cohort of young people aged 15 to 24 – known as the 'infection cohort' – for two years. Participants recruited into the infection cohort were tested using the QuantiFERON Gold Plus (QFT-G+) test for TB infection in the blood. Testing at baseline revealed a high prevalence of TB infection, with 64% of South African participants and 33% of Zambian participants testing positive. The baseline findings demonstrated that the prevalence of infection significantly increased with age in both countries, and increased with the presence of a household contact of TB in Zambia, but not in South Africa.
The research team is in the final stages of data analysis and write up. We hope that the TREATS project will make important contributions to the fight against TB. More information on TREATS is available here.
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