Universal access to cotrimoxazole prophylaxis:An essential life-extending treatment for people living with HIV and TB

Current State of Affairs

Cotrimoxazole – also known as Bactrim or Septra – is a wide spectrum antibacterial drug that is highly effective in treating and preventing common opportunistic infections (OIs) among adults and children living with HIV and/or tuberculosis (TB). The drug is widely available and affordable in most settings, costing just $0.0022/dose to $0.0047/dose in the international market1.

Since March 2000, cotrimoxazole use has been recommended by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS)
as a life-extending treatment for people living with HIV(PLHIV). In 2004, the WHO, UNAIDS, and the United Nations Children Fund (UNICEF) also recognized the vital role of cotrimoxazole prophylaxis in saving the lives of infants and children exposed to/infected with HIV in a joint statement calling the drug “a crucial potentially life saving intervention…” Yet, despite these provisional guidelines on its use, most countries have not widely implemented cotrimoxazole as a priority, life extending treatment.

Last year, the WHO convened an expert consultation to revisit the issue of cotrimoxazole prophylaxis for adults and children. At the meeting, new recommendations were drafted and experts advised the WHO to develop clear and consistent messages on the need and value of cotrimoxazole prophylaxis, and to provide technical assistance to countries to increase its use. In addition, it was recommended that regional and global targets should be developed to monitor
access to the drug. To date, none of these recommended actions have been taken, nor have revised guidelines been published.

Despite the proven effectiveness of cotrimoxazole in extending the lives of people with HIV and TB, access to this simple, cheap, life-extending treatment is low, especially in the Asia-Pacific region. Furthermore, people living with HIV and TB are not always aware of the benefits of cotrimoxazole. For example, a survey on cotrimoxazole use among PLHIV conducted by the AIDS-Care-Watch Campaign (June 2006), found that awareness of the drug varied significantly . One respondent from Bolivia reported: “People who are in networks of [people living with HIV/AIDS] are [aware of the potential benefits of cotrimoxazole], those who are not, are left to the good will and knowledge of medical doctors who are often not trained in HIV, not even basic [care and treatment].”2

Recommendations

People living with HIV and TB in poorer parts of the world are often challenged by a variety of infectious diseases, which place them at greater risk of developing HIV-related opportunistic infections. The AIDS-Care-Watch Campaign strongly recommends a set of urgent actions to increase availability of drugs to treat and prevent OIs, in particular:

• WHO: Should immediately publish revised guidelines on cotrimoxazole prophylaxis for children and adults, and set time-bound regional and global targets for universal access to cotrimoxazole prophylaxis.

• Government bodies: Should integrate WHO guidelines on cotrimoxazole prophylaxis and treatment for adults and children into national AIDS-related care policies and guidelines.

• Health care settings: Medical services should actively increase availability and systematic provision of cotrimoxazole to children and adults exposed to and/or living with HIV and/or TB, in accordance with international and national treatment guidelines.

1 According to the international drug price indicator guide, 2005
2 ACW Campaign 2006 Survey on Cotrimoxazole, June 2006 Universal access to cotrimoxazole prophylaxis: An essential life-extending treatment for people living with HIV and TB