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Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV

DOI: 10.1590/S0042-96862010000400010

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objective: to measure progress in implementing co-trimoxazole prophylaxis (ctxp) (trimethoprim plus sulfamethoxazole) and isoniazid preventive therapy (ipt) policy recommendations, identify barriers to the development of national policies and pinpoint challenges to implementation. methods: in 2007 we conducted by e-mail a cross-sectional survey of world health organization (who) hiv/aids programme officers in 69 selected countries having a high burden of infection with hiv or hiv-associated tuberculosis (tb). the specially-designed, self-administered questionnaire contained items covering national policies for ctxp and ipt in people living with hiv, current level of implementation and barriers to developing or implementing these policies. findings: the 41 (59%) respondent countries, representing all who regions, comprised 85% of the global burden of hiv-associated tb and 82% of the global burden of hiv infection. thirty-eight countries (93%) had an established national policy for ctxp, but only 66% of them (25/38) had achieved nationwide implementation. for ipt, 21 of 41 countries (51%) had a national policy but only 28% of them (6/21) had achieved nationwide implementation. despite significant progress in the development of ctxp policy, the limited availability of co-trimoxazole for this indication and inadequate systems to manage drug supply impeded nationwide implementation. inadequate intensified tuberculosis case-finding and concerns regarding isoniazid resistance were challenges to the development and implementation of national ipt policies. conclusion: despite progress in implementing who-recommended ctxp and ipt policies, these interventions remain underused. urgent steps are required to facilitate the development and implementation of these policies.


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