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Largest ever study on the impact of combined HIV/TB intervention on tuberculosis

£10.5m project will examine effect of ‘testing and treating’ a whole population of sub-Saharan African communities in tackling the disease
Caption: man holding lung x-ray. Credit: the Union

The impact of a combined TB and HIV intervention in tackling tuberculosis when delivered to the entire population of 14 urban, high prevalence communities in South Africa and Zambia, is to be measured in a new £10.5m multi-partner project led by the London School of Hygiene & Tropical Medicine (LSHTM).

The TREATS (Tuberculosis Reduction through Expanded Anti-retroviral Treatment and Screening) Consortium, will measure the effect of universal TB testing and treatment through house to house visits on TB prevalence and infection rates over four years.

TB and HIV are the leading infectious causes of death worldwide – in 2016 1.7 million people died of TB. For people living with HIV, TB is the most significant co-infection, 40% of HIV deaths in 2016 were due to TB.

TREATS aims to inform new policies and approaches for tackling the TB / HIV epidemic. As the global health community works towards ambitious new goals to end TB, TREATS will provide invaluable new information for accelerating effective interventions.

Dr Helen Ayles, TREATS Project Director, Professor of Infectious Diseases at LSHTM and Research Director at Zambart, said: “TREATS is a unique opportunity to assess a combined TB and HIV intervention on a massive scale. It will provide amazing data and hopefully some practical solutions to end TB. TB is a curable illness, but in order to better reach people with treatment, we need to understand the epidemiology of the disease better. This is true active case-finding.”

The TREATS study is linked to the HPTN 071 (PopART) trial - the largest ever trial of a combination HIV prevention strategy. This trial is being conducted across 21 communities in Zambia and South Africa, covering around one million people in total. PopART involves universal testing and treatment for HIV through house-to-house visits on an annual basis over four years, from 2014 to2018. As part of PopART, all community members are also screened for TB.

Building on PopART, TREATS will measure the impact of this combined TB / HIV intervention on tuberculosis. The project runs until 2021, and will measure the prevalence of active TB as well as the incidence of TB infection in adolescents. It also includes: a social science component to better understand stigma related to TB; mathematical and economic modelling to provide answers for how future large-scale interventions can be undertaken effectively; use of the newest tools available for diagnosing TB infection and operating effectively on a large scale

TREATS consortium members are London School of Hygiene & Tropical Medicine and members include Imperial College London, Zambart, KNCV Tuberculosis Foundation, Sheffield University, the International Union Against Tuberculosis and Lung Disease (The Union), Health Systems Trust, Delft Imaging Systems and QIAGEN.

The project is part of the European and Developing Countries Clinical Trials Partnership, (EDCTP2 programme) supported by the European Union.