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.