Compliance with cotrimoxazole prophylaxis for the prevention of opportunistic infections in HIV-positive tuberculosis patients in Thyolo district, Malawi

OBJECTIVE: To verify compliance with cotrimoxazole prophylaxis in human imm unodeficiency virus (HIV) infectcd tuberculosis (TB) patients during the co ntinuation phase of anti-tuberculosis treatment, and to assess the sensitiv ity, specificity and positive predictive values of verbal verification and pill counts as methods of checking compliance. DESIGN: Cross-sectional study. METHODS: Cotrimoxazole compliance was assessed in a cohort of TB patients w ho were attending four TB followup centres during the continuation phase of anti-TB treatment between months 4 and 6. Verbal verification of drug inta ke, physical verification of pill count balance, and urine trimiethoprim. d etection by gas chromatography and in ass spectrometry were used for assess ing compliance. RESULTS: Using urine trimethoprim detection as the gold standard for compli ance, trimethoprim was detected in 82 (94%) of 87 patients in the cohort. V erbal verification of cotrimoxazole intake and objective pill count balance s showed high sensitivity and positive predictive values compared with the gold standard of urine trimethoprim. detection. CONCLUSIONS: In a rural district in Malawi, compliance with cotrimoxazole a s an adjunct to anti-tuberculosis treatment in HIV-infected TB patients was good, and can be assessed simply and practically by verbal verification an d pill counts.