POLICY – Co-trimoxazole Prophylaxis for HIV-Exposed and HIV-Infected Infants and Children: Practical approaches to implementation and scale up

Co-trimoxazole prophylaxis is safe, inexpensive and highly effective in reducing morbidity and mortality among HIV-infected infants and children. WHO recommends that all HIV-exposed infants be started on co-trimoxazole prophylaxis at four to six weeks of age to provide adequate prevention against early opportunistic infections. This is particularly critical for HIV-infected infants. However, despite the fact that countries have developed and put in place policies to support the scale up and implementation of co-trimoxazole prophylaxis for infants and children, and that it is inexpensive, life-saving, safe, and theoretically simple to deliver, UNICEF, WHO and partners estimate that in 2008, only 8% of children exposed to HIV were initiated on co-trimoxazole prophylaxis by two months of age.

This guide was developed to assist national programme managers and implementing partners to effectively implement and rapidly scale up the uptake of co-trimoxazole prophylaxis within the context of existing HIV and MNCH programmes. Developing reliable national- and district-level procurement and supply management mechanisms that ensure a consistent supply of co-trimoxazole for paediatric prophylaxis needs is identified as one of the six key strategies for scaling up national responses. The actions required at the national and district levels to establish procurement and supply systems that can support national programme scale up efforts are outlined in the document.

This document was developed by WHO and UNICEF on behalf of the Expanded Inter-Agency Task Team (IATT) on Prevention of HIV Infection in Pregnant Women, Mothers and their Children and with the collaboration of multiple organizations working to improve pediatric HIV prevention, care and treatment.

The document is available in English. The publication can be downloaded at