Initial S' pneumoniae Findings in Cotrimoxazole Prophylaxis Study Kisumu, Kenya

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Initial S. pneumoniae Findingsin Cotrimoxazole
Prophylaxis StudyKisumu, Kenya
Netspear Meeting November, 2003
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CDC/KEMRI Research Station

• CDC and the Kenya Medical Research Institute
  (KEMRI) collaboration since 1979
• Malaria
• HIV
• Other infectious diseases
• Well-developed field and laboratory
  infrastructure
• Antimicrobial resistance testing
• Bacterial diarrheal pathogens since 1997
• Bacterial respiratory pathogens since 2002

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CDC/KEMRI Research Station Western Kenya
CDC/KEMRI Clinical Research Center (CRC) at
Provincial Hospital
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Objectives

• In HIV-infected clients on daily CTX, to assess
• S. pneumoniae
• - trends in CTX-resistant and
  PCN-resistant pneumococci colonization
• P. falciparum
• - change in prevalence of molecular
  markers of antifolate resistance
• - clinical and parasitologic response
• E. coli and diarrheal pathogens
• - trends in CTX-resistant E. coli
  colonization
• - the effect of CTX on the etiology of
  diarrhea in HIV-infected clients

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MethodsA prospective, non-randomized cohort
study with 3 arms
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Eligibility

• Inclusion Criteria
• gt 18 years old
• Willing to undergo HIV testing
• Can attend monthly visits at the research clinic
• Exclusion Criteria
• 1st trimester pregnancy
• Known sulfa allergy
• Taking daily antibiotic (unless for TB treatment)

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Data Collection

• Clinic visits every 2 wks first month, then
  monthly for 6 months
• Sample Collection
• Nasopharyngeal swab (Sp)
• Fingerstick blood sample (Pf)
• Rectal swab/stool sample (Ec)
• MICs

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Characteristics of HIV-infected Clients
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Baseline Pneumococcal Carriage by Study Arm
n462
n206
24
20
Clients
n65
11
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Pneumococcal Carriage by Study Arm Baseline and
Week 2
Clients
n462
n206
N179
n400
n68
n60
n65
10
16
19
n29
11
20
24
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CTX Susceptibilities for S. pneumoniae
Isolatesin HIV-infected Carriers on CTX
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Clients on CTX Carrying CTX Non-susceptible S.
pneumoniae
Clients
?
24
19
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Penicillin (PCN) Susceptibilites for S.
pneumoniae in HIV-infected Carriers on CTX
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Clients on CTX Carrying PCN Non-susceptible S.
pneumoniae
Clients
?
18
14
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(No Transcript)
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Adherence

• Evaluated by
• Clients self-report
• Nurses pill count
• At Month 2, 339/401 (85) reported NOT missing
  ANY study pill
• Of the 62 who missed any pill, 74 missed only
  1-5 pills

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Recent Antibiotic Use Prior to 1st Visit
Clients
(n147)
(n345)
(n44)
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Antimicrobials Used Among All Clients before 1st
Clinic Visit (n536)
Penicillin
SP42
Amoxicillin
TB meds
CTX25
Doxycycline
Clients
Erythromycin
CTX
SP/Fansidar
Last 1 month
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Initial S. pneumoniae Findings