Professor Nulda Beyers, co-director of the Desmond Tutu TB Centre at the University of Stellenbosch believes the TB burden is massive and that it is critical to start working towards a ‘€œgeneration free of TB’€.

‘€œThis is why the cure rates are so important. If we can keep cure rates (in the adults) up there then we have a strong case for a generation of infection-free children,’€ says Beyers.

However, Beyers points out that their research among school children revealed ‘€œshockingly high’€ rates of latent TB infection.

‘€œBut at the end of the day the health workers can only do so much. It becomes the responsibility of each and every person to be diagnosed, tested and cured.

‘€œThe responsibility of everyone in each community is also to support patients and to make sure that the children in these communities do not get infected with TB,’€ adds Beyers.

Beyers points out that in much poorer countries such as Tanzania, Mozambique and Sudan, the levels of infected children was rock bottom.

‘€œI think our problem is not a nurse issue or a drug issue of a patient issue. It is a middle management issue. The national department can have a brilliant programme, but the problems come in when you get lower down,’€ says Beyers.

Beyers and her team of clinical researchers have been working closely with Professor Paul van Helden’€™s laboratory at the University to Stellenbosch,   conducting clinical, epidemiological, anthropological, operational, genetic and molecular research for more than a decade.  

They recenctly embarked on Zamstar (Zambia South Africa TB and AIDS Reduction Study), a six-year collaborative research project (between Stellenbosch University, Zambia and the London School of Hygiene and Tropical Medicine) in which two public health interventions that provide a radically different approach to diagnosis, prevention and care will be tested.

The first intervention aims to reduce TB through raising community awareness and giving people direct access to TB tests.

The second aims to deliver integrated TB and hIv care directly to affected households.

The total population involved in the study is about 1.2 million people, consisting of about 50,000 people in 24 communities, eight in South Africa and 16 in Zambia.   Each community will be randomly allocated to receive one or other intervention or neither or both.  

The primary outcome will be the prevalence of culture positive TB among a randomly selected population of adults in each arm of the trial, measured after 3 years of the interventions.

Secondary outcomes include indicators of TB and HIV programme performance and changes in HIV incidence and stigma at the household level.  

‘€œOur preliminary studies show that the interventions are feasible, affordable and likely to reduce the prevalence of tuberculosis by 30-50% within a few years,’€ explains Beyers.

Beyers and her research team are currently testing hundreds of Cape Town school children for latent TB infection as part of the Zamstar intervention.

Children are tested for TB infection to determine the extent of the growing TB problem in the community and country.

As part of the tests, teachers and children also receive education about TB and children are asked to draw pictures and poster depicting their understanding of TB.

Testing the extent of the TB infection in the community involves giving skin tests to children. This skin test consists of an injection into the skin, which is given with a small needle.

After 72 hours the skin reaction which develops (almost like an allergic reaction to the TB bacterium) is measured and recorded.

Parents are informed of the results of the test.   It is important to note that positive result indicates exposure to TB (latent TB) and not TB disease.

Pupils with a positive skin test and signs/symptoms of TB are referred to the nearest health centre for further investigations.

The study will return to the schools in three years to re-test the children to find out whether the rate of infection with TB has reduced or not.

‘€œOnce we have the results from these skin test surveys, we will know how far we are from a generation of infection-free children in the Western Cape. This will give us a good indication of the how big the TB problem really is,’€ Beyers adds.

E-mail Anso Thom