Cotrimoxazole: Positioning and encouraging “new” and “essential” use

Issue: With the scale up of HIV treatment programs, substantial funding has been committed to guarantee an uninterrupted supply of cotrimoxazole for persons living with HIV as cotrimoxazole is a well-tolerated, inexpensive antibiotic that has been shown to reduce the risk of pneumonia, diarrhea, malaria, and other opportunistic infections among persons with HIV. It is effective across a wide range of CD4 cell counts. With the scale up of HIV treatment programs, substantial funding has been committed to guarantee an uninterrupted supply of cotrimoxazole but access to this key intervention remains inconsistent. Key barriers to cotrimoxazole access/administration are related to the supply chain and limited awareness of the benefits of cotrimoxazole use among health care providers and service recipients. Currently, AIDSTAR-One has finalized 15 systematic country reviews of the global and country level supply chain issues that provide a situation analysis, document promising practices, and make recommendations to strengthen systems. Complementing this work, AIDSTAR-One is also developing provider and patient tools to increase both use of and access to cotrimoxazole for opportunistic infections.

Lessons learned: Findings revealed through the 15 country desk reviews, include many supply chain challenges posing obstacles to ensure cotrimoxazole availability for all uses. And conversely, there are many innovative approaches that validate successful supply chains that require technical expertise, resources, and policymakers' commitment.

Recommendations are collapsed under five topics to consider when working toward improving availability of health commodities. These include access, quality, efficiency, financing, and collaboration in low-resource countries.