HPTN 071 (PopART) is a 3-arm community-randomised trial in 21 communities, 12 in Zambia and 9 in South Africa, which aims to determine the impact of a combination prevention intervention on HIV incidence. Community HIV care providers (CHiPs) are responsible for the delivery of the intervention and linkage to care. A combination HIV prevention package that includes door-to-door HIV testing and TB screening is offered in 8 of 12 communities in Zambia (total adult population of approximately 214,000).
Individuals gave verbal consent to take part in the study intervention..A standard symptom questionnaire (screening tool) delivered by the CHiPs was used to detect any three of the most common signs or symptoms of TB (weight loss, cough for ≥2 weeks, and/or night sweats). For adults with ≥1 of these three most common symptoms, the CHiP teams collected two sputum samples and delivered them to the clinic for diagnosis using either smear microscopy or Gene X-pert. TB positive adults were started on TB treatment at the clinic. The household intervention is delivered in annual rounds, and data was analyzed from the first annual round or the period November 2013 up to June 2015 for Zambia only.
During this period 102, 511 households in the 8 communities were visited, 97% of households consented to enumeration of household members (99,129), and 84% of adult household members consented to participate (212,819 of 253,750 members). 123,272 were males and median age was 29 among adults who consented to participate, 98.4% (209,429/212,819) were screened for TB. Of those screened, 1.2% (2,583/209,429) were symptomatic for TB and of those symptomatic 74.3% (1,918/2,583) were followed up and received a test result for TB. Among adults who received a test result, 8.7% (167/1,918) had a positive test result and 79.6% (133/167) were started on TB treatment (see figure 1). Overall TB notification rate was 650/100,000 (167/209,429 x 100,000 = 650). Adults with a positive TB test result who are not known to have started TB treatment are being followed up to ensure that they are all linked to care.
We found 9% new TB cases among people with signs and symptoms of TB that would not otherwise have been identified. Screening large numbers of individuals for TB using a simple screening tool as part of a large, community-based household HIV intervention is feasible and can contribute towards active case finding and linkage to care.