COTRIMOXAZOLE PROPHYLAXIS LESSONS AND WAY FORWARD LESSONS LEARNT

COTRIMOXAZOLE PROPHYLAXIS LESSONS AND WAY FORWARD

LESSONS LEARNT South Africa: • Eligible = HIV+ve Stage 2, 3, 4 • Increasing uptake (Ugu) • Reasonable adherence Malawi: • Eligible = HIV+ve TB patients • Uptake low (15%) • Many patients continue post TB treatment

RECOMMENDATIONS FROM PROTEST • Feasible to administer (operationally easy) • Patients like to take CPT • CPT can be part of a package of care HOWEVER • No information about efficacy • No data on how to continue post-TB Rx in HIV+ve TB patients

INFORMATION STILL NEEDED: FROM PROTEST • Long term adherence rates in HIV-positive non-TB patients from SA? • Post-treatment adherence in TB patients who have completed anti-TB treatment from Malawi?

INFORMATION FROM ELSEWHERE HIV-POSITIVE NON-TB PATIENTS: • Data from Cote d”Ivoire and SA on morbidity and mortality already published conflicting results • RCT in Zambia - results to come

INFORMATION FROM ELSEWHERE HIV-POSITIVE TB PATIENTS: • Efficacy data from Cote d’Ivoire and SA showing effect (published) • Efficacy data from Senegal - showing no effect (published) • Operational research from Malawi showing effect (in press and submitted) • RCT from Zambia - to be completed

WHAT DO WE NEED TO KNOW FROM RESEARCH • Proof of principle studies eg, proper efficacy studies or well done OR studies in both HIV+ve TB and non-TB patients • Exploration of why CPT works • Studies of what CPT in many patients might do to Anti-malarial drug resistance • How to deliver CPT post-TB treatment • The need for CPT in the advent of ART

ADDENDUM WHO to commission a review of: where we are with CPT - addressing TB and non-TB patients, why it might work, future areas of research and likely need for CPT in the advent of ART