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.