Johns Hopkins Medicine
Office of Corporate Communications
Media Contacts:
Baltimore: David March
410-955-1534; [email protected]
Geneva: Carole Francis, WHO Stop TB, +41 79 54 079 56; [email protected]
March 24, 2005


The Johns Hopkins-based Consortium to Respond Effectively to the AIDS/TB Epidemic (CREATE) today 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 Richard E. Chaisson, MD, professor of medicine at Johns Hopkins University and principal investigator of CREATE.  “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% 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 3-4% annually.

CREATE, funded by the Bill and Melinda Gates Foundation, was launched by Nelson Mandela at the July 2004 International AIDS Conference. Mandela described his own battle with TB during his imprisonment in South Africa during the apartheid era, and urged an assault on TB/HIV, stating "We cannot fight AIDS unless we do much more to fight TB as well". 

CREATE includes, besides Hopkins, Aurum Health Research (South Africa), London School of Hygiene and Tropical Medicine (UK), Municipal Health Secretariat Communicable Disease Program Rio de Janeiro (Brazil) and The World Health Organization - Stop TB Department (Geneva).

With the goal of reducing death and disease from TB in AIDS-endemic populations, consortium partners have designed 3 projects in South Africa, Zambia and Brazil.  All three studies have moved into implementation in recent weeks.  A description of the trials is given below.
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 additional services within the households of TB patients:  TB tests as well as free HIV counseling and testing.  ZAMSTAR recently celebrated its launch in Cape Town in a ceremony at Stellenbosch University featuring Nobel laureate Archbishop Desmond Tutu.

THRio: In Brazil, the THRio project, in 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, under the renowned Brazilian AIDS program.  The THRio study team earlier this month selected the clinics in which the project will be launched later this year.

Thibela - TB (Prevent TB):  This project will be carried out in gold mines located in three South African Provinces.  The project will determine whether TB preventive therapy given to an entire high risk community is more effective than TB preventive therapy given to high risk individuals only. More than 50,000 miners will be included in the study.  The Thibela TB team recently had a public lottery where specific gold mines were given assignments as mass preventive treatment or control sites based on a random drawing.

The CREATE studies will produce information about strategies for improving TB control in areas affected by HIV over the next 5-6 years.  Working with WHO ensures that CREATE project results reach global and national policy-makers so that the best methods of reducing death and disease are followed in all countries.