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Effects of cotrimoxazole on malaria

Overview

This group will investigate the population-level impact of cotrimoxazole prophylaxis taken by people with HIV on the incidence and transmission of malaria in Uganda and/or Kenya.

Things to consider

• This group is recommended for:
  • Participants interested in data management
  • Participants interested in national-level estimates
  • Participants interested in population-level analyses and national-scale estimation
  • Participants interested in comparing simple estimation and model-based estimation
• This group will have the opportunity to engage in any of the following:
  • Data cleaning and data collation
  • Parameter estimation and epidemiological calculations
  • Fitting simple models and making projections with uncertainty

Background

Malaria and HIV are linked through the antibiotic cotrimoxazole. Routine HIV care in Kenya and Uganda includes use of cotrimoxazole for anyone with HIV as daily prophylaxis to prevent opportunistic infections. Though not specifically intended to prevent malaria, cotrimoxazole reduces an individual’s risk of malaria infection by 25-90% in clinical trials and observational studies conducted in sub-Saharan Africa. Cotrimoxazole also reduces the risk of parasite being found in the blood, which may mean that individuals taking cotrimoxazole are also less likely to transmit malaria parasites back to mosquitoes. This project will estimate how use of the antibiotic cotrimoxazole as part of routine HIV care may be impacting malaria burden based on the sub-national geographic distribution of the two diseases.

Data

• UNAIDS Subnational estimates of HIV for Uganda prevalence
• Kenya AIDS Progress Report 2014
• Antiretroviral therapy and cotrimoxazole provided by PEPFAR, 2009-2014 by district (Uganda) and county (Kenya)
• Uganda National Malaria Control Program
• Kenya National Malaria Control Program
• Uganda Census 2014
• Kenya Census 2009

References

• Bwakura-Dangarembizi, M, L Kendall, S Bakeera-Kitaka, et al. (2014) A randomized trial of prolonged co-trimoxazole in HIV-infected children in Africa. New England Journal of Medicine 370(1): 41-53.
• Whitworth, J, D Morgan, M Quigley, A Smith, B Mayanja, H Eotu, et al. (2000) Effect of HIV-1 and increasing immunosuppression on malaria parasitaemia and clinical episodes in adults in rural Uganda: a cohort study. The Lancet 356: 1051-1056.
• Kasirye, RP, K Baisley, P Munderi, J Levin, Z Anywaine, A Nunn, et al. (2016) Incidence of malaria by cotrimoxazole use in HIV infected Ugandan adults on antiretroviral therapy: a randomized placebo controlled study. AIDS 30: 635-643.
• Suthar AB, Vitoria MA, Nagata JM, Anglaret X, Mbori-Ngacha D, Sued O, et al. (2015) Co-trimoxazole prophylaxis in adults, including pregnant women, with HIV: a systematic review and meta-analysis. The Lancet HIV 2: e137-150.
• Malaria Atlas Project
• Penfold, S, V Simms, J Downing, RA Powell, F Mwangi-Powell, E Namisango, et al. (2014) The HIV basic care package: where is it available and who receives it? Findings from a mixed methods evaluation in Kenya and Uganda. AIDS Care 26: 1155-1163.
• Cameron, E, KE Battle, S Bhat, DJ Weiss, D Bisanzio, B Mappin, U Dalrymple, SI Hay, DL Smith, JT Griffin, EA Wenger, PA Eckhoff, TA Smith, MA Penny, & PW Gething (2015) Defining the relationship between infection prevalence and clinical incidence of Plasmodium falciparum malaria.