title: Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV.
abstract: OBJECTIVE
  To measure progress in implementing co-trimoxazole prophylaxis (CTXp) (trimethoprim plus sulfamethoxazole) and isoniazid preventive therapy (IPT) policy recommendations, identify barriers to the development of national policies and pinpoint challenges to implementation.
  
  
  METHODS
  In 2007 we conducted by e-mail a cross-sectional survey of World Health Organization (WHO) HIV/AIDS programme officers in 69 selected countries having a high burden of infection with HIV or HIV-associated tuberculosis (TB). The specially-designed, self-administered questionnaire contained items covering national policies for CTXp and IPT in people living with HIV, current level of implementation and barriers to developing or implementing these policies.
  
  
  RESULTS
  The 41 (59%) respondent countries, representing all WHO regions, comprised 85% of the global burden of HIV-associated TB and 82% of the global burden of HIV infection. Thirty-eight countries (93%) had an established national policy for CTXp, but only 66% of them (25/38) had achieved nationwide implementation. For IPT, 21 of 41 countries (51%) had a national policy but only 28% of them (6/21) had achieved nationwide implementation. Despite significant progress in the development of CTXp policy, the limited availability of co-trimoxazole for this indication and inadequate systems to manage drug supply impeded nationwide implementation. Inadequate intensified tuberculosis case-finding and concerns regarding isoniazid resistance were challenges to the development and implementation of national IPT policies.
  
  
  CONCLUSIONS
  Despite progress in implementing WHO-recommended CTXp and IPT policies, these interventions remain underused. Urgent steps are required to facilitate the development and implementation of these policies.
authors.affiliation: Global AIDS Program, Centers for Disease Control and Prevention, Atlanta, GA, United States of America. adate@cdc.gov
authors.forename: Anand A
authors.initials: AA
authors.lastname: Date
authors.forename: Marco
authors.initials: M
authors.lastname: Vitoria
authors.forename: Reuben
authors.initials: R
authors.lastname: Granich
authors.forename: Mazuwa
authors.initials: M
authors.lastname: Banda
authors.forename: Mayada Youssef
authors.initials: MY
authors.lastname: Fox
authors.forename: Charlie
authors.initials: C
authors.lastname: Gilks
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000188:drug therapy*; D020276:HIV Long-Term Survivors; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D011640:Public Policy; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*; D014944:World Health Organization
chemical_list: D000890:Anti-Infective Agents; D000995:Antitubercular Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D007538:Isoniazid