2. ZAMSTAR  24 communities in 2 countries  > 1million people  Embedded in the health systems of the 2 countries  Study end point will be prevalence surveys after 3 years of intervention  Programmatic data will highlight the operational challenges of implementing TB/HIV collaborative activities

3. Prevalence Sites Rural Zambia Medium South Africa Dense South Africa Peri-urban Zambia

4. Key findings confirm the ZAMSTAR Rationale  The burden of tuberculosis is huge culture- positive prevalence of 960/100,000 in the two Zambian sites and 2,200/100,000 in the two South African sites (14,894 adults)  Many adults with a chronic cough have never sought care in their local health center, and even when they have, they have often not been offered available diagnostic tests

5. Study Sites 24 study sites have been established 2 national TB Programmes, 6 Provinces, 10 Districts, 29 clinics and communities have been engaged and have bought into study protocols

6. The communities have been randomized

7. ZAMSTAR Enhanced Case Finding  Encourage community to seek testing ▪Community drama ▪School-based programme ▪Clinic-based service  Remove barriers to sputum microscopy ▪Open access service ▪Within 30 minutes of home ▪Results returned within 48 hours  Different communities respond to different approaches.

8. Enhancing case-finding by removing barriers and empowering communities ECF OutreachSchool InterventionOpen Access lab 1. Recruit additional microscopists 2. Develop IEC 3. Establish ECF register 4. QA 1. Develop school TB/HIV curriculum 2. Twice yearly intervention in all schools in intervention area 3. Establish ECF register 4. QA 1. Develop IEC/Outreach activities 2. Weekly Outreach activities 3. Establish ECF register 4. QA

9. Diagnosed Missed One year Several years ZAMSTAR Rationale

10. Diagnosed Missed 8 months Several years

11. ECF Community Mobilisation –> 300 Drama performances per year –> 60,000 IEC materials distributed per year Schools Interventions –70 Schools involved Open Access/Fast Track sputum collection points

13. Yield of cases Total+Total% Yield Clinic 7,29240,50718 VCT3523,7519 ECF81210,2518 HH558796

14. The ZAMSTAR Team Plus the London gang!