The TREATS (Tuberculosis Reduction through Expanded Antiretroviral Treatment and Screening for Active TB) project, funded by EDCTP, is measuring the success of a ‘universal test and treat’ project called PopART in reducing the prevalence and incidence of TB in Zambia and South Africa. These findings will help to define new policies and approaches for tackling the TB-HIV epidemic. The project is conducted in 21 urban, high prevalence communities in South Africa and Zambia.
The project consists of four linked studies that will provide evidence of the effect of the household-level combined HIV and TB prevention intervention on the burden of TB at population level.

The two main outputs are:
1. Provide definitive evidence of the effectiveness of scaled-up combination TB/HIV prevention interventions on TB;
2. Improve understanding of the best ways to measure the impact of public health interventions on TB burden.

KNCV has a leading role in the implementation of the Prevalence Survey. This survey targets to collect data on 56,000 participants over the project duration. The survey was launched end of February in Zambia and end of March in South Africa after successful completion of pilot studies in both countries and through testing of an innovative digital Data Management System. In the first communities in both countries a so-called intensive diagnostic phase was conducted to gain key insight in the optimal diagnostic algorithm for the survey using a combination of GeneXpert ULTRA and culture as diagnostic tests. Global discussion arose after recent national TB prevalence survey showed discordant results making interpretation of results and how to define what is a TB case challenging.

TREATS presented the key intensive diagnostic phase findings on GeneXpert ULTRA and culture results during a symposium at the Union World Conference, titled: “Lessons learnt from national TB prevalence surveys using culture and Xpert MTB/RIF, TB or not TB?“ in October 2019. The findings were very well received and are an important contribution to the global discussion on how to optimize the conduct of TB prevalence surveys.

Fieldwork will continue with an adjusted algorithm minimizing the use of culture. Field work is expected to be completed in Q3 of 2020.

Countries: Zambia and South Africa