Combined Effect of Co-trimoxazole Prophylaxis and Safe Water on Diarrhea amongst HIV-Exposed Infants and People Living with HIV/AIDS: A Systematic Review

Abstract

Aim: Irrespective of co-trimoxazole prophylaxis, diarrhea among HIV-exposed infants (HEI) and people living with HIV and AIDS (PLWHA) remains unacceptably high. We aimed to determine the combined effect of improved water supply interventions and co-trimoxazole prophylaxis on frequency and severity of diarrhea among HEI and PLWHA. Methods: Using key search terms of safe sanitation, improved water supply, WaSH, co-trimoxazole prophylaxis, HIV-exposed, PLWHA, morbidity, mortality, diarrhea; we searched for published articles in PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases guided by the acceptance practice developed by PROSPERO and COCHRANE. A PRISMA flow diagram was used to explain on the number of articles retrieved, retained, excluded and justifications for every action. A Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the methodology of the selected studies. Results: Safe water and co-trimoxazole together reduced diarrhea episodes by up to 67% (IRR _ 0.33, 95% CI 0.24–0.46, P < 0.0001). The combined interventions resulted in 27% risk reduction in HIV disease progression whilst safe water alone was associated with reductions in the longitudinal prevalence of reported diarrhea of up to 53% among HEI aged ≤2 years (LPR = 0.47, 95% CI: 0.30–0.73, P < 0.001). Conclusion: The combined effect of co-trimoxazole and safe water was significantly higher than when each one of them were to be offered alone. An expanded WaSH response is critical to prevent diarrhea. Registration: CRD42021240512.