Established in 2006, the CIDRZ TB Department assists the Zambian Ministry of Health (MOH) in reducing the burden of TB in Zambia. We support Ministry TB healthcare programmes, conduct clinical research and integrate implementation science within our service programmes.
Our research focuses on combating the Zambian and global TB burden through identifying evidence-based methods to scale up intensified TB case-finding; improving treatment for TB infected and TB/HIV co-infected patients; and testing TB vaccines and improved diagnostic methods for use in resource-limited settings.
In 2011 over 43,000 new cases of TB were diagnosed in Zambia making it among one of the highest burden countries in the world (WHO TB Global TB Report 2012). 70% of identified TB patients are co-infected with HIV making it critical to improve diagnosis and treatment of both infections.
Supporting Zambia to Eliminate TB in HIV-infected Patients
As of March 2014, CIDRZ has supported the MOH in screening almost 43,000 TB patients for HIV and 390,000 HIV-infected patients for TB; and has linked over 40,000 TB/HIV co-infected patients to treatment with anti-TB drugs and antiretroviral therapy. Through close collaboration with the MOH and the National TB Programme, CIDRZ works to enhance screening, diagnosis and management of TB in 337 clinic sites in 12 districts in Lusaka, Western, Southern and Eastern provinces.
CIDRZ has introduced systems to ensure that HIV-infected TB patients are efficiently linked to HIV care and treatment. This includes a pilot programme integrating HIV care into TB clinics providing a “one-stop” approach designed to improve patient convenience and facilitate both TB and HIV care.
CIDRZ has also been instrumental in piloting more sensitive and rapid TB diagnostic technology (Gene Xpert MTB/RIF) for use in both rural, urban and prison settings. CIDRZ is operationalizing two CDC-funded implementation science programmes, both aimed at enhancing TB diagnosis in HIV-infected patients: Op-X, introduces Gene Xpert MTB/RIF into rural HIV clinics; while the 3 ‘I’s includes Intensified case finding using Xpert MTB/RIF in district hospitals and clinics, Improved infection control and provision of Isoniazid preventive therapy. Previously, we conducted the CDC-funded Cohort study, to ascertain the burden of TB in HIV-infected patients and enhance systems for TB screening and linking to care.
Supporting Zambia to Eliminate TB in Vulnerable Populations
CIDRZ also provides screening for other vulnerable populations. By integrating routine TB screening in Maternal Child Health clinics we screened over 5000 pregnant women, and through World Health Organization Stop TB Partnership TB REACH funding, we implemented a TB/HIV screening programme for over 7600 inmates in 6 Zambian prisons.
With European Union funding we will continue our prison work by collaborating with the Zambian Prison Service to establish health management teams to assist in establishing a sustainable framework for prison health care.
Laboratory Support for TB Research and Programmes
CIDRZ has conducted research of novel TB diagnostic tools including LED fluorescence microscopes, urinary lipoarabinomannan (LAM) and computer-assisted digital x-ray interpretation technology. We have also conducted U.S. National Institutes of Health-funded Adult AIDS Clinical Trials Group research trying to improve strategies to manage TB/HIV co-infected patients, and will be part of the 2014 AERAS-funded TB vaccine trial.
The CIDRZ Mycobacteriology Laboratory supports our research efforts. This regional reference facility has both culture and molecular diagnostic capacity processing up to 16,000 primary specimens per year.
Diagnostic modalities available include: fluorescence and Ziehl-Neelsen (ZN) smear microscopy, liquid (MGIT 960) and solid (LJ) culture, line probe assay for rapid identification of mycobacterium and drug susceptibility testing, blood culture capacity, and first and second line drug susceptibility testing using liquid culture as well as Gene Xpert MTB/RIF.
Since 2007, the CIDRZ TB Department has trained almost 1,900 healthcare workers in Provider Initiated Testing and Counselling, TB and HIV management and chest x-ray interpretation.
We have extensive experience conducting TB and HIV trainings for community members, volunteer treatment supporters, peer educators and clinicians. We are also working with partners to develop an e-learning programme for X-ray interpretation.