Cotrimoxazole prophylaxis, which prevents deaths and hospital admissions across all ages of individuals with HIV infection in resource-limited countries, is cheap. Economic research in adults in Uganda, and more recently in children in Zambia, has shown that Cotrimoxazole is highly cost-effective. Specific research in Zambia has even found that it could be cost saving: if all HIV-infected children in Zambia received Cotrimoxazole prophylaxis, the net effect could be savings to the health system in the range of US$2.9 - 9.6 million per year.
Earlier research demonstrated that, in both adults and children with HIV infection not on antiretroviral therapy (ART), low dose Cotrimoxazole cuts deaths by nearly one half and hospital admissions by around one quarter. As a result of this research, WHO and UNAIDS issued statements in 2004, followed by updated WHO Guidelines in 2006, advocating the use of Cotrimoxazole prophylaxis as a key element of pre-ART care for children, adolescents and adults. However, there is evidence that this message is not being taken up. In 2006, UNAIDS figures estimate that only 4% of adults and 1% of children with HIV have access to Cotrimoxazole. Greater commitment is needed at national and international levels to ensure that this simple, life-saving drug is accessible to all who need it. This recent evidence of cost-effectiveness highlights that lives can be saved at very low cost.
Evidence For Action Policy Briefing Issue 01, July 2008, 4 pp.