July 2006
Mermin J, Ekwaru JP, Liechty CA, et al.; Lancet 2006;367:1256
The authors from the CDC have established a community outreach HIV care program for poor patients living in an area of high intensity for malaria transmission in rural Uganda. The present study began in 2001 and represents incremental additions to the malaria prophylaxis program. The four sequential stages of the plan are summarized in the following table:
| Phase | Intervention | No. persons | Date | | 1 | None | 466 | April 01-Aug. 01 | | 2 | TMP-SMX | 399 | Sept. 01-March 03 | | 3 | ART | 138 ART +
897 new pts | May 03-April 04 | | 4 | Bednets | 989 | May 04-Nov. 05 |
| Phase | Intervention | N | Malaria rate/100 p-yrs | Risk ratio | | 1 | None | 466 | 50.8 | 1 | | 2 | TMP-SMX | 399 | 9.0 | 0.24* | | 3 | TMP-SMX + ART | 1035 | 3.5 | 0.08* | | 4 | TMP-SMX + ART + | 989 | 2.1 | 0.05* |
p = < 0.001
The results of the study showed an extraordinary decrease in the rate of malaria from 50.8/100 person-years at baseline to 2.1/100 person-years with the full compliment of TMP-SMX, antiretroviral therapy for those with HIV infection and bednets. This represents a 25 fold reduction in the rate of malaria. The authors conclude that their study shows benefit that is substantial in the magnitude and highly significant by statistical analysis.
Commentary:
There has been considerable thought to the importance of the PEPFAR program and the Global Fund in terms of treating not only HIV infection, but also for establishing an infrastructure to deliver other potential health benefits. A prior report from this group indicated that the annual cost of TMP-SMX was approximately $15/year and the bednet cost about $5 [Mermin J, Lule J, Ekwaru JP, et al. Lancet 2004;364:1428]. This certainly provides substantial support for these programs in developing countries which is quite independent of their benefit for HIV management. Literature Review by John G. Barlett, MD, Professor, Division of Infectious Diseases Return to Literature Review main page | 
