2.12.2 Key References and Supporting WHO Guidelines

Anglaret X et al. (1999) Early chemoprophylaxis with trimethoprim-sulphamethoxazole for HIV-1 infected adults in Abidjan, Cote d' Ivoire: a randomised trial. Cotrimo-CI study group. Lancet. 353:1463-1468.

Badri, M., Ehrlich, R., Wood, R., & Maartens, G. (2001). Initiating co-trimoxazole prophylaxis in HIV-infected patients in africa: An evaluation of the provisional WHO/UNAIDS recommendations. AIDS (London, England), 15(9), 1143-1148.

Bell, J. C., Rose, D. N., & Sacks, H. S. (1999). Tuberculosis preventive therapy for HIV-infected people in Sub-Saharan Africa is cost-effective. AIDS (London, England), 13(12), 1549-1556.

Bucher, H. C., Griffith, L. E., Guyatt, G. H., Sudre, P., Naef, M., Sendi, P., et al. (1999). Isoniazid prophylaxis for tuberculosis in HIV infection: A meta-analysis of randomized controlled trials. AIDS (London, England), 13(4), 501-507.

Godfrey-Faussett P. (2003) District-randomised phased implementation: strengthening the evidence base for cotrimoxazole for HIV positive tuberculosis patients. AIDS. 17:1079-1081.

Hawken, M. P., & Muhindi, D. W. (1999). Tuberculosis preventive therapy in HIV-infected persons: Feasibility issues in developing countries. The International Journal of Tuberculosis and Lung Disease: The Official Journal of the International Union Against Tuberculosis and Lung Disease, 3(8), 646-650.

Marseille, E., Saba, J., Muyingo, S., & Kahn, J. G. (2006). The costs and benefits of private sector provision of treatment to HIV-infected employees in Kampala, Uganda. AIDS (London, England), 20(6), 907-914.

Maynart M et al. (2001) Primary prevention with cotrimoxazole for HIV-1 infected adults: results of the pilot study in Dakar, Senegal. Journal of Acquired Immunodeficiency Syndrome. 26:130-136.

Smart, T. (2009) Continuous isoniazid preventive therapy (IPT) better at preventing TB than short course-but only in those with a positive tuberculin skin test. HIV & AIDS Treatment in Practice.151.

Wiktor SZ et al. (1999) Efficacy of trimethoprim-sulphamethoxazole prophylaxis to decrease the morbidity and mortality in HIV-1 infected patients with tuberculosis in Abidjan, Cote d'Ivoire: a randomised controlled trial. Lancet. 353:1469-1475.

Zachariah R et al. (2001) Compliance with cotrimoxazole prophylaxis for the prevention of opportunistic infections in HIV-positive tuberculosis patients in Thyolo district, Malawi. International Journal of Tuberculosis and Lung Disease. 5:843-846.

Zachariah R et al. (2002) Cotrimoxazole prophylaxis in HIV infected individuals after completing antituberculosis treatment in Thyolo, Malawi. International Journal of Tuberculosis and Lung Disease. 6:1046-1050.

Zachariah R et al. (2003)Voluntary counselling, HIV testing and adjunctive cotrimoxazole reduces mortality in tuberculosis patients in Thyolo, Malawi. AIDS. 17:1053-1061.

Supported by Existing Guidelines:

TB infection control, 2009- Section 3.3.2
o Intensified case finding 3.3.2 Control 9 - Provide a package of prevention and care interventions for health workers including HIV prevention, antiretroviral therapy a isoniazid preventive therapy for HIV positive health workers All health workers should be given appropriate information and encouraged to undergo TB diagnostic investigation if they have signs and symptoms suggestive of TB (19). Similarly, all health workers should be given appropriate information and encouraged to undergoHIV testing and counselling. If diagnosed with HIV, they should be offered a package of prevention treatment and care that includes regular screening for active TB and access to antiretroviral therapy. Based on the evaluation, health workers should be put on either isoniazid preventive therapy (IPT) or a full regimen of anti-TB treatment, should they be diagnosed with active TB. HIV-positive health workers should not be working with patients with known or suspected TB (in particular, they should not be working with patients with MDR-TB and XDR-TB), and they should be relocated from positions where exposure to untreated TB is high to a lower risk area. Remarks: IPT is effective in people living with HIV because it reduces the risk of developing active TB. Incidence of TB also decreases in HIV-positive cohorts on antiretroviral therapy. Health workers are more exposed to TB than the general population; thus, HIV-positive health workers are a priority group for IPT.

WHO, Stop TB Partnership and Department of HIV/AIDS, 2003- Section C3
o Co-trimoxazole preventive therapy is promoted by WHO and UNAIDS for the prevention of several secondary bacterial and parasitic infections in eligible adults and children living with HIV in Africa. Tuberculosis patients are eligible for this therapy. This interim policy builds on the provisional WHO/UNAIDS secretariat recommendations on the use of co­trimoxazole prophylaxis in adults and children living with HIV in Africa.

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