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AIDSTAR-One Co-trimoxazole Series: Resources to Increase & Sustain Use

Co-trimoxazole (also known as Septrin) is a well-tolerated, inexpensive, and cost-effective antimicrobial that reduces the risk of pneumonia, diarrhea, malaria, and other infections among people living with HIV. Although considered a standard of HIV care in higher-income countries, access to Co-trimoxazole is inconsistent in lower-income countries. Limited awareness of the benefits of Co-trimoxazole use among health care providers and service recipients is a key barrier to its access and use. Responding to this barrier, AIDSTAR-One developed and piloted provider and patient educational tools to increase appropriate prescription and use of co-trimoxazole for eligible people living with HIV. This collection includes those tools, a technical needs assessment report, and a summary report of the pilot project.

Cover of Septrin Dosage Formulations and Dosage for Infants, Children, and Adults Living with or Exposed to HIV

Septrin Dosage Formulations and Dosage for Infants, Children, and Adults Living with or Exposed to HIV

Co-trimoxazole (also known as Septrin) is a well-tolerated, inexpensive, and cost-effective antimicrobial that reduces the risk of pneumonia, diarrhea, malaria, and other infections among people living with HIV. Although considered a standard of HIV care in higher-income countries, access to Co-trimoxazole is inconsistent in lower-income countries. Limited awareness of the benefits of Co-trimoxazole use among health care providers and service recipients is a key barrier to its access and use(1).

Responding to this barrier, AIDSTAR-One developed provider and client educational tools to increase prescription and use of Co-trimoxazole for eligible individuals. The materials were based on the WHO guidelines and drafted with input from technical experts at USAID and CDC and from clinicians and behavior change specialists in Uganda. Between May and August 2012, AIDSTAR-One piloted the draft tools in Northern Uganda, seeking feedback from a range of stakeholders on the acceptability and appropriateness of the tools. Although the tools were well-received across all stakeholder groups, a few minor edits were recommended and have since been incorporated into the materials.

These tools are designed to meet the needs of both providers and clients, complementing in-country Co-trimoxazole guidelines. They include images that are easy to understand and were designed to be used in low-literacy settings. The tools targeting health providers emphasize the benefits of Co-trimoxazole, provide dosage information, and include details of eligibility and contraindications. The materials targeting clients (adults, children, and infants) depict the benefits of Co-trimoxazole, describe how and when Co-trimoxazole should be taken, and recommend when to seek care in the presence of side-effects.

The tools are inter-related and can be presented as a poster, as job aids for health workers, and as an informational take-home brochure for clients. The tools were designed to be easily adapted for use in any country and can be displayed at health care settings, in community locations, and/or used at the household level by community health workers, caregivers, or clients.

Cover of Septrin Job Aid

Septrin Job Aid

Co-trimoxazole (also known as Septrin) is a well-tolerated, inexpensive, and cost-effective antimicrobial that reduces the risk of pneumonia, diarrhea, malaria, and other infections among people living with HIV. Although considered a standard of HIV care in higher-income countries, access to Co-trimoxazole is inconsistent in lower-income countries. Limited awareness of the benefits of Co-trimoxazole use among health care providers and service recipients is a key barrier to its access and use(1).

Responding to this barrier, AIDSTAR-One developed provider and client educational tools to increase prescription and use of Co-trimoxazole for eligible individuals. The materials were based on the WHO guidelines and drafted with input from technical experts at USAID and CDC and from clinicians and behavior change specialists in Uganda. Between May and August 2012, AIDSTAR-One piloted the draft tools in Northern Uganda, seeking feedback from a range of stakeholders on the acceptability and appropriateness of the tools. Although the tools were well-received across all stakeholder groups, a few minor edits were recommended and have since been incorporated into the materials.

These tools are designed to meet the needs of both providers and clients, complementing in-country Co-trimoxazole guidelines. They include images that are easy to understand and were designed to be used in low-literacy settings. The tools targeting health providers emphasize the benefits of Co-trimoxazole, provide dosage information, and include details of eligibility and contraindications. The materials targeting clients (adults, children, and infants) depict the benefits of Co-trimoxazole, describe how and when Co-trimoxazole should be taken, and recommend when to seek care in the presence of side-effects.

The tools are inter-related and can be presented as a poster, as job aids for health workers, and as an informational take-home brochure for clients. The tools were designed to be easily adapted for use in any country and can be displayed at health care settings, in community locations, and/or used at the household level by community health workers, caregivers, or clients.

Cover of Septrin brochure

Adult Living with HIV: Septrin Brochure

Co-trimoxazole (also known as Septrin) is a well-tolerated, inexpensive, and cost-effective antimicrobial that reduces the risk of pneumonia, diarrhea, malaria, and other infections among people living with HIV. Although considered a standard of HIV care in higher-income countries, access to Co-trimoxazole is inconsistent in lower-income countries. Limited awareness of the benefits of Co-trimoxazole use among health care providers and service recipients is a key barrier to its access and use(1).

Responding to this barrier, AIDSTAR-One developed provider and client educational tools to increase prescription and use of Co-trimoxazole for eligible individuals. The materials were based on the WHO guidelines and drafted with input from technical experts at USAID and CDC and from clinicians and behavior change specialists in Uganda. Between May and August 2012, AIDSTAR-One piloted the draft tools in Northern Uganda, seeking feedback from a range of stakeholders on the acceptability and appropriateness of the tools. Although the tools were well-received across all stakeholder groups, a few minor edits were recommended and have since been incorporated into the materials.

These tools are designed to meet the needs of both providers and clients, complementing in-country Co-trimoxazole guidelines. They include images that are easy to understand and were designed to be used in low-literacy settings. The tools targeting health providers emphasize the benefits of Co-trimoxazole, provide dosage information, and include details of eligibility and contraindications. The materials targeting clients (adults, children, and infants) depict the benefits of Co-trimoxazole, describe how and when Co-trimoxazole should be taken, and recommend when to seek care in the presence of side-effects.

The tools are inter-related and can be presented as a poster, as job aids for health workers, and as an informational take-home brochure for clients. The tools were designed to be easily adapted for use in any country and can be displayed at health care settings, in community locations, and/or used at the household level by community health workers, caregivers, or clients.

Cover of Co-Trimoxazole Management and Availability

Co-Trimoxazole Management and Availability: Logistics and Supply Chain Experience in 15 PEPFAR Countries

Co-trimoxazole is a simple, well-tolerated, inexpensive antibiotic. When taken regularly as prophylaxis, co-trimoxazole reduces mortality and specifically reduces the risk of pneumonia, diarrhea, malaria, and other opportunistic infections (OIs) in adults and children living with HIV. The World Health Organization (WHO) recommends co-trimoxazole is included as an integral component of the HIV chronic care package as it is key to pre-antiretroviral therapy (ART) care (WHO 2006). It is listed on WHO’s Model List of Essential Medicines in the “Other antibacterials” category (WHO 2010). Co-trimoxazole is also used in primary health care (PHC) to treat infections of the eyes, ears, skin, and genitourinary and respiratory tracts, among other infections (WHO 2008), thus rendering it a high-priority public health product.

With the scale-up of HIV care and treatment programs, substantial funding has been committed to guarantee an uninterrupted supply of co-trimoxazole for people living with HIV (PLWH), but access to this key intervention remains inconsistent. Anecdotal evidence suggests some of the product provided through donor-supported HIV programs is being used in PHC, but this is hard to verify given the fact that many health logistics systems do not track the source of the product. However, concern about leakage of donated co-trimoxazole into PHC is warranted when PLWH lack access because the product provided by donors for HIV programs is out of stock.

Following the implementation of the co-trimoxazole chemoprevention guidelines, the demand for product outpaced availability, resulting in stockouts when the supply pipelines were not adequately filled prior to implementing the guidelines. In general, in the 15 countries included in this analysis, stock imbalances were eventually corrected as donor inputs for HIV programs augmented national government procurement.

Cover of Pilot Co-trimoxazole Tools Assessment, Gulu, Uganda

Pilot Co-trimoxazole Tools Assessment, Gulu, Uganda

Co-trimoxazole is a well-tolerated, inexpensive, and cost-effective antimicrobial that has been shown to reduce the risk of pneumonia, diarrhea, malaria, and other opportunistic infections among people living with HIV (PLHIV). However, limited awareness of the benefits of co-trimoxazole use among health care providers and service recipients continues to be a key barrier to its use (Anand et al. 2010). AIDSTAR-One developed provider and patient educational tools to increase appropriate prescription and use of co-trimoxazole for PLHIV eligible for its use and piloted these tools in Northern Uganda between May and August 2012. AIDSTAR-One conducted a mixed-methods assessment pre- and post-pilot to analyze the effectiveness and acceptability of the co-trimoxazole tools.

The pilot began with introduction of the tools as well as baseline data collection. At baseline both providers and clients were able to easily identify the messages in the co-trimoxazole tools. They indicated the text and the images were simple, clear, and concise. Feedback provided by health providers, clients, and stakeholders was taken into account and small revisions were made to further increase the cultural relevance of the tools in Uganda.

Prior to introduction of the tools, providers reported heavy client loads prevented them from providing adequate counseling related to co-trimoxazole to all patients. Clients indicated that, although they utilize co-trimoxazole, most had not received counseling beyond being instructed to take co-trimoxazole daily. At baseline, 31 percent of adults reported missing doses, and 37 percent of caregivers reported failing to administer doses of co-trimoxazole to children/infants in their care in the previous week, emphasizing the need for tools to improve adherence. At follow-up, adult clients reported higher levels of adherence to their co-trimoxazole prescriptions (only 20 percent reported missing doses in the previous week). Almost all clients (97 percent) who reported viewing the co-trimoxazole pilot tools reported they would be more likely to remember to take co-trimoxazole each day because of the tools.