Background

Zambart is a Zambian research organisation established in 2004 from a research collaboration between the School of Medicine  University of Zambia and the London School of Hygiene and Tropical Medicine (LSHTM) that spans over 20 years. From the initial studies of the impact of HIV on the clinical presentation and outcome of Tuberculosis, the scope and partnership of the research have expanded widely.

Based in the School of Medicine Ridgeway campus of the University of Zambia in Lusaka, Zambart has grown to become one of the leading research groups supporting healthcare advances in TB and HIV. Since 1989, Zambart has actively partnered with the Zambian government through direct collaboration in healthcare research. Zambart also works closely with other research organizations and academic institutions within Africa, and worldwide to help innovatively reduce the public-health burden caused by the dual epidemics in resource-limited communities in Zambia and beyond.

Staff

Zambart is comprised of a multi-disciplinary team offering diverse expertise in epidemiology, clinical science, social science, operations research, health systems and services research, health policy analysis, health economics and health communications, and laboratory techniques for TB and HIV with new additional tests being incorporated. Our researchers have successfully conducted world-class clinical and epidemiological studies with measurable results.

Our Commitment

Bridging research and action through operational research and through forging effective collaboration with local stakeholders.

• Providing evidence-based and high quality research.
• Addressing relevant and priority questions.
• Capacity building – managerial, technical and scientific (inherent in Zambart’s approach).

Approach

Zambart works with a range of Zambian collaborators in HIV and TB, both private and public:

• Addressing specific research questions through the application of clinical trials, laboratory work and action research and using and developing innovative research methods.
• Strengthening local capacity in University Teaching Hospital (UTH), Medical School, Lusaka District health management Team, CBOs through training on and participation in research, local workshops, development of training materials, teaching, supervision and distance based and international Diplomas, Masters and Doctorate programmes.
• Supporting national institutions– UTH, TB/HIV working group, MTCT working group, ARV scientific panel, District health management teams, National TB reference Laboratory (CDL), KCTT,  District AIDS Task Force, NAC Treatment and Care working group.

 Research

Zambart recent past has focussed on the overlap between HIV and TB and aims to improve the quality of life of people affected by the epidemics.

Zambart has recently completed the largest ever TB/HIV intervention trial – Zambia-South Africa TB and AIDS Reduction (ZAMSTAR), a joint collaboration with the LSHTM and the Desmond Tutu TB Center at Stellenbosch University in South Africa, conducted as part of the CREATE consortium. This trial found that a household level intervention of combined TB/HIV care reduced both the prevalence of tuberculosis in adults and new Tuberculosis infections in children when measured at the community level.

Zambart is currently conducting the HPTN 071 study / Population effect of Antiretroviral Therapy to reduce HIV, another large cluster randomized trial. In this trial, 21 communities with over 1 million people will be randomly allocated to receive a combination HIV prevention package that includes universal HIV testing with the offer of immediate access to ART to those found HIV positive regardless of their CD4 count, medical male circumcision, and provision of VCT and condoms at household level.

Translating Research Into Policy

Zambart has been successful in influencing national, regional and international policy through its research findings, these include:

• Impact of HIV on TB epidemiology used by Zambian MoH to plan future services.
• Preventive therapy results incorporated into WHO guidelines
• Ongoing transmission results feed into rationale for new STOP TB TB/HIV working group combined TB/HIV strategy.
• Urban TB studies led to trials of transporting sputum and led to LDHMT proposing for a Action Research Unit, which was established with support from DFID.
• CBOs forum established to develop a TB curriculum for voluntary caregivers and training workshops run and evaluated.
• CBOs recognised as partners in TB Control in Lusaka.
• ProTEST initiative formed the basis for the International policy on TB/HIV collaborative activities. This policy has been adopted nationally and internationally·
• Anti-stigma toolkit published and adopted in many countries
• Levels of TB drug resistance do not necessitate a change in treatment regiments for TB at present.
• Revision of TB/HIV record keeping through the National TB/HIV Working Group.

Priorities For Future Research

The epidemiology of the dual TB/HIV epidemic:

• Strengthening of health systems to deliver effective health services and improve TB and HIV control
  Laboratory strengthening
• Integration of TB and HIV care
• Alternative approaches to TB case-finding and diagnosis
• Chronic care management using TB/HIV as an example
• Prevalence of TB and HIV
• Prevalence of TB infection (surveys)
• Drug Resistance Surveillance
• The converging socio-economic impact of TB and HIV on poor communities

Collaborations

Zambart has been actively involved in regional and international research consortia e.g. TARGETS, Evidence for Action, CREATE consortium. Internationally, Zambart is recognised as one of the foremost TB/HIV research groups in the world. Representatives sit on the WHO TB/HIV working group and have assisted in the writing of WHO technical guidelines and policy documents.