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Müller P, Velez Lapão L. Mixed methods systematic review and metasummary about barriers and facilitators for the implementation of cotrimoxazole and isoniazid-Preventive therapies for people living with HIV. PLoS One 2022; 17:e0251612. [PMID: 35231047 PMCID: PMC8887777 DOI: 10.1371/journal.pone.0251612] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 02/10/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Cotrimoxazole and isoniazid preventive therapy (CPT, IPT) have been shown to be efficacious therapies for the prevention of opportunistic infections and tuberculosis (TB) among people living with human immunodeficiency virus (HIV). Despite governments' efforts to translate World Health Organization recommendations into practice, implementation remains challenging. This review aimed to explore and compare CPT and IPT with respect to similarities and differences of barriers identified across high TB/HIV burden countries. A secondary objective was to identify facilitators for implementing both preventive therapies. METHODS We searched MEDLINE, Web of Science and SCOPUS databases for peer-reviewed literature published before September 2020. We extracted and synthesized our findings using Maxqda software. We applied framework synthesis in conjunction with metasummary to compare both therapies with respect to similarities and differences of barriers identified across seven health system components (in line with the modified WHO's Framework for action). Protocol registration: PROSPERO (CRD42019137778). FINDINGS We identified four hundred and eighty-two papers, of which we included forty for review. Although most barrier themes were identical for both preventive therapies, we identified seven intervention-specific themes. Like for CPT, barriers identified for IPT were most frequently classified as 'service delivery-related barriers' and 'patient & community-related barriers'. 'Health provider-related barriers' played an important role for implementing IPT. Most facilitators identified referred to health system strengthening activities. CONCLUSIONS For researchers with limited working experience in high TB/HIV burden countries, this review can provide valuable insights about barriers that may arise at different levels of the health system. For policymakers in high TB/HIV burden countries, this review offers strategies for improving the delivery of IPT (or any newer therapy regimen) for the prevention of TB. Based on our findings, we suggest initial and continuous stakeholder involvement, focusing on the efficient use and reinforcement of existing resources for health.
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Affiliation(s)
- Pia Müller
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisboa, Portugal
| | - Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisboa, Portugal
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Manirakiza A, Tondeur L, Ketta MYB, Sepou A, Serdouma E, Gondje S, Bata GGB, Boulay A, Moyen JM, Sakanga O, Le-Fouler L, Kazanji M, Briand V, Lombart JP, Vray M. Cotrimoxazole versus sulfadoxine-pyrimethamine for intermittent preventive treatment of malaria in HIV-infected pregnant women in Bangui, Central African Republic: A pragmatic randomised controlled trial. Trop Med Int Health 2021; 26:1314-1323. [PMID: 34407273 DOI: 10.1111/tmi.13668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The main objective of the MACOMBA (Maternity and Control of Malaria-HIV co-infection in Bangui) trial was to show that cotrimoxazole (CTX) is more effective than sulphadoxine-pyremethamine-IPTp (IPTp-SP) to prevent placental malaria infection (primary end point) among HIV-positive pregnant women with a CD4+ count ≥350 cells/mm3 in Bangui, CAR. METHODS MACOMBA is a multicentre, open-label randomised trial conducted in four maternity hospitals in Bangui. Between 2013 and 2017, 193 women were randomised and 112 (59 and 53 in CTX and IPTp-SP arms, respectively) were assessed for placental infection defined by microscopic parasitaemia or PCR. RESULTS Thirteen women had a placental infection: five in the CTX arm (one by microscopic placental parasitaemia and four by PCR) and eight by PCR in the SP-IPTp (8.5% vs. 15.1%, p = 0.28). The percentage of newborns with low birthweight (<2500 g) did not differ statistically between the two arms. Self-reported compliance to CTX prophylaxis was good. There was a low overall rate of adverse events in both arms. CONCLUSION Although our results do not allow us to conclude that CTX is more effective, drug safety and good compliance among women with this treatment favour its widespread use among HIV-infected pregnant women, as currently recommended by WHO.
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Affiliation(s)
- Alexandre Manirakiza
- Institut Pasteur of Bangui, International Network of Instituts Pasteur, Bangui, Central African Republic
| | - Laura Tondeur
- Institut Pasteur of Paris, Unité d'Epidémiologie des Maladies Emergentes, Paris, France
| | | | - Abdoulaye Sepou
- Hôpital Communautaire of Bangui, Ministry of Health, Bangui, Central African Republic
| | - Eugène Serdouma
- Hôpital de l'Amitié, Ministry of Health, Bangui, Central African Republic
| | - Samuel Gondje
- Maternité de la Gendarmerie, Ministry of Health, Bangui, Central African Republic
| | | | - Aude Boulay
- Institut Pasteur of Paris, Unité d'Epidémiologie des Maladies Emergentes, Paris, France
| | - Jean Methode Moyen
- Malaria Programme Division, Ministry of Health, Bangui, Central African Republic
| | - Olga Sakanga
- Institut Pasteur of Bangui, International Network of Instituts Pasteur, Bangui, Central African Republic
| | - Lenaig Le-Fouler
- Institut Pasteur of Paris, Unité d'Epidémiologie des Maladies Emergentes, Paris, France
| | | | - Valerie Briand
- Inserm, Institut de Recherche pour le Développement, University of Bordeaux, Bordeaux, France
| | - Jean Pierre Lombart
- Institut Pasteur of Bangui, International Network of Instituts Pasteur, Bangui, Central African Republic
| | - Muriel Vray
- Institut Pasteur of Paris, Unité d'Epidémiologie des Maladies Emergentes, Paris, France.,National Institut of Medical Research, Paris, France
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