Prevalence and factors associated with malaria parasitaemia among adults living with HIV following discontinuation of cotrimoxazole prophylaxis at Kitgum Hospital

Abstract

Background: The effect of discontinuation of cotrimoxazole prophylaxis on malaria parasitaemia among patients on antiretroviral therapy (ART) who have regained immune competence and living in a malaria endemic area remains unknown.

Objective: We determined the prevalence and factors associated with malaria parasitaemia among people living with HIV following discontinuation of cotrimoxazole preventive therapy at the Kitgum hospital HIV clinic.

Methods: This was a cross sectional study conducted between March and April 2019 at the Kitgum hospital HIV clinic. We consecutively enrolled 599 participants aged 18 years and above and living with HIV attending the clinic. A questionnaire was administered to the participants, and a physical exam conducted. All participants provided a finger-prick thick blood smear which was stained with Giemsa and used to assess for the presence of malaria parasites. Factors associated with malaria parasitaemia among those who had been discontinued on cotrimoxazole were assessed using logistic regression.

Results: Of the 599 participants enrolled, 452 (75.5%) had stopped cotrimoxazole prophylaxis for at least 3 months. The overall prevalence of malaria parasitaemia was 4.5% (95% Confidence Interval [CI] 3.0% - 6.5%). There was a significant difference in malaria parasitaemia prevalence among participants who had stopped cotrimoxazole (5.5%; 95% CI 3.6% - 8.1%) compared to participants on cotrimoxazole prophylaxis (1.4%; 95% CI 0.17 - 4.83, p=0.034). Factors associated with malaria parasitaemia included increasing duration following the discontinuation of prophylaxis (adjusted odds ratio [aOR] 1.79, 95%CI 1.225 - 2.621, p = 0.003). CD4 count greater than 250 cells/ul (aOR 0.17, 95%CI 0.071 - 0.426) and bed net use the night prior to the survey (aOR 0.31, 95%CI 0.105 - 0.906) were protective against malaria parasitaemia.

Conclusions: Adults living with HIV who stopped cotrimoxazole prophylaxis for at least 3 months had a significantly higher prevalence of malaria parasitaemia compared to those on prophylaxis. Increased duration was associated with increasing odds of having parasites while IRS, bed-net use and high CD4 count were associated with protection against having malaria parasites.

Recommendation: These results suggest that malaria preventive methods including IRS and bed-net use should be promoted in adults living with HIV in whom cotrimoxazole prophylaxis is being discontinued.