AEGiS-13IAC: Cotrimoxazole prophylaxis in HIV positive TB patients in a rural distirct of Malawi.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Cotrimoxazole prophylaxis in HIV positive TB patients in a rural distirct of Malawi.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. TuOrB278)

Zachariah R, Harries AD, Spielmann MP, Salaniponi F, Arendt V, Gomani P, Selemani N, Hargreves NJ, Kwanjana JH
R. Zachariah, MSF-Luxembourg PO Box 30353, Chichiri Blantyre 3, Malawi, Tel.: +265 644 409, Fax: +265 641 468, E-mail: msflblantyre@malawi.net

BACKGROUND: Following results of the Cote d'Ivoire cotrimoxazole prophylaxis study in HIV positive TB patients, an operational research study was launched in a rural district of Malawi with the objective of verifing the possible feasibility of implementing cotrimoxazole prophylaxis within a district set-up, and its possible impact on reducing mortality and hospitalisation rates.

METHODS: From the 1st of July 1999, all TB patients in Thyolo district of Malawi, are offered voluntary HIV and cotrimoxazole related counselling as well as HIV testing. HIV positive TB patients are offered cotrimoxazole prophylaxis if there are no contraindications, and the patients are closely monitored.

RESULTS: In the first 6 months of the study, a total of 592 tuberculosis (TB) patients were registered. 535 (90.4%) were counselled, while 57 (9.6%) refused counselling, died or were transferred out. 507 (85.6%) did HIV testing, 25 (4.7%) refused HIV testing while 49 (9.7%) died or were transferred out before testing. HIV seroprevalence among all TB patients tested (n = 507) was 77%. HIV seroprevalence by TB types: smear positive 155 (67.4%), smear negative 91 (83.5%), extrapulmonary 144 (84.7%). 384 (98.5%) HIV positive TB patients were placed on cotrimoxazole. In 6 (1.5%) cotrimoxazole was contraindicated. There were 5 (1.3%) that had skin reactions, out of which only 2 (0.7%) had to stop cotrimoxazole. Intensive phase mortality rate for the 3rd quarter of 1999 for patients on cotrimoxazole was 9.4% compared to 12.6% for the same period in 1998 for patients that were not on cotrimoxazole.

CONCLUSIONS: It has been possible to effectively implement counselling, HIV testing, and cotrimoxazole prophylaxis, within a rural district context and the system is functioning efficiently. HIV seroprevalence in TB patients is high and cotrimoxazole compliance is good. Side effects to cotrimoxazole have been minimal but it is still early to make statistical conclusions on mortality rates with available data.

Keywords: AEGIS, Trimethoprim-Sulfamethoxazole Combination, HIV Infections, HIV Seropositivity, Tuberculosis, HIV Seroprevalence, Counseling, Patient Compliance, Self Administration, Malawi, Cote d'Ivoire, Human, prevention & control, therapy, drug therapy
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TuOrB278