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The newspaper of The Johns Hopkins University April 11, 2005 | Vol. 34 No. 29
Studies Are Set to Fight TB/HIV in Africa, Brazil

The Johns Hopkins-based Consortium to Respond Effectively to the AIDS/TB Epidemic, known as CREATE, has announced the start of three studies to evaluate novel techniques for controlling HIV-related TB in countries hard hit by the dual epidemics.

"Innovative public health measures to contain AIDS-related TB are urgently needed in the developing world," said principal investigator Richard E. Chaisson, professor in the School of Medicine. "CREATE's community-level studies will assess bold new approaches for driving down the skyrocketing rates of TB in areas with severe HIV epidemics."

The World Health Organization's Global Tuberculosis Control 2005 report notes that global TB prevalence has declined by more than 20 percent since 1990 and that incidence rates are now falling or stable in five of the six WHO regions of the world. The exception is Africa, where TB incidence rates have tripled since 1990 in countries with high HIV prevalence and continue to rise across the continent at 3 percent to 4 percent annually.

CREATE, funded by the Bill and Melinda Gates Foundation, was launched by Nelson Mandela at the July 2004 International AIDS Conference.

In addition to Johns Hopkins, CREATE participants are Aurum Health Research, South Africa; London School of Hygiene and Tropical Medicine; Municipal Health Secretariat Communicable Disease Program Rio de Janeiro, Brazil; and the WHO Stop TB Department, Geneva.

With the goal of reducing death and disease from TB in AIDS-endemic populations, the partners have designed three projects in South Africa, Zambia and Brazil, which have all moved into implementation.

ZAMSTAR, the Zambia and South Africa Tuberculosis and AIDS Reduction Study, plans to empower communities to seek care for their tuberculosis, providing direct access to diagnostic services and increasing community awareness. The project will provide TB tests and free HIV counseling and testing within the households of TB patients.

In Brazil, the THRio project, a collaboration with the Health Department in Rio de Janeiro, will introduce preventive TB therapy to patients receiving HIV treatment in 29 public clinics in that city.

The Thibela TB project will be carried out in gold mines located in three South African provinces and will determine whether TB preventive therapy given to an entire high-risk community is more effective than TB preventive therapy given only to high-risk individuals. More than 50,000 miners will be included in the study.

The CREATE studies will produce information about strategies for improving TB control in areas affected by HIV over the next five to six years. Working with WHO ensures that the results will reach global and national policy-makers so that the best methods of reducing death and disease are followed in all countries.


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