Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Homsy J, Dorsey G, Arinaitwe E. et al. Protective efficacy of prolonged co-trimoxazole prophylaxis in HIV-exposed children up to age 4 years for the prevention of malaria in Uganda: a randomised controlled open-label trial. Lancet Glob Health 2014; 2: e727–36. Appendix Homsy et al. - Protective efficacy of prolonged cotrimoxazole prophylaxis against malaria in Ugandan children up to age 4 years Table A. Incidence of complicated malaria among HIV-exposed, -unexposed and -infected children according to cotrimoxazole (CTX) randomisations and age ranges Episodes PY Incidence PPY On CTX 2 105.5 0.019 HIV-exposed HIV-exposed Randomised to stop CTX Randomised to continue CTX 6 3 86.9 104.1 0.069 0.029 HIV-unexposed Not on CTX 5 145.7 0.034 HIV-infected On CTX 0 73.5 0 HIV status CTX prophylaxis status IRR (95% CI) p-value Enrolment – end of BF HIV-exposed N/A Before age 2 years† Reference group 0.46 (0.09-2.33) 0.35 Between age 2 years and 4 years HIV-exposed HIV-exposed CTX stopped after cessation of BF CTX stopped at 2 years of age 10 14 151.2 89.9 0.066 0.156 Reference group 2.68 (0.70-10.2) 0.15 HIV-exposed Randomised to continue CTX 8 83.4 0.096 1.56 (0.37-6.57) 0.55 HIV-unexposed Not on CTX 7 164.8 0.042 0.87 (0.23-3.24) 0.83 HIV-infected On CTX 1 62.4 0.016 0.29 (0.41-3.99) 0.30 Reference group N/A - Between age 4 years and 5 years HIV-exposed HIV-exposed CTX stopped after cessation of BF CTX stopped at 2 years of age 2 0 69.7 42.4 0.029 0 HIV-exposed CTX stopped at 4 years of age 0 36.2 0 HIV-unexposed Not on CTX 1 76.8 0.013 HIV-infected On CTX 0 22.8 0 45 14 863.6 451.7 0.052 0.031 N/A 0.59 (0.02-15.9) 0.75 N/A Enrolment - age 5 years All groups Not on CTX On CTX Reference group 0.45 (0.41-0.50) <0.0001 PY= person-years of follow-up. PPY=Per person-year of follow-up. IRR= incidence rate ratio. CTX=cotrimoxazole. BF=breastfeeding. Malaria incidence rate ratio with 95% confidence interval, controlling for place of residence and antimalarial treatment arm † For randomised groups, incidence is from cessation of breastfeeding to 2 years of age. For observational cohorts, incidence is from enrolment (6 weeks-12 months of age) to 2 years of age. Observational cohorts, not randomised. 1 Appendix Homsy et al. - Protective efficacy of prolonged cotrimoxazole prophylaxis against malaria in Ugandan children up to age 4 years Table B. Incidence of all-cause hospitalizations among HIV-exposed, -unexposed and -infected children according to cotrimoxazole (CTX) randomisations and age ranges Episodes PY Incidence PPY On CTX 13 105.5 0.123 N/A HIV-exposed HIV-exposed Randomised to stop CTX Randomised to continue CTX 8 15 86.9 104.1 0.092 0.144 Reference group 1.86 (0.65-5.33) 0.25 HIV-unexposed HIV-infected Not on CTX On CTX 11 9 145.7 73.5 0.075 0.122 HIV status CTX prophylaxis status IRR (95% CI) p-value Enrolment – end of BF HIV-exposed Before age 2 years† Between age 2 years and 4 years HIV-exposed HIV-exposed CTX stopped after cessation of BF CTX stopped at 2 years of age 13 17 151.2 89.9 0.086 0.189 Reference group 2.68 (0.76-9.43) 0.13 HIV-exposed Randomised to continue CTX 15 83.4 0.180 2.59 (0.72-9.25) 0.14 HIV-unexposed Not on CTX 8 164.8 0.049 0.71 (0.21-2.40) 0.58 HIV-infected On CTX 4 62.4 0.064 0.84 (0.18-3.88) 0.83 Reference group N/A - Between age 4 years and 5 years HIV-exposed HIV-exposed CTX stopped after cessation of BF CTX stopped at 2 years of age 2 0 69.7 42.4 0.029 0 HIV-exposed CTX stopped at 4 years of age 0 36.2 0 HIV-unexposed HIV-infected Not on CTX On CTX 1 0 76.8 22.8 0.013 0 0.59 (0.02-15.9) N/A 0.75 38 43 328.0 293.0 0.116 0.147 Reference group 1.27 (0.80- .2.01) 0.29 N/A Enrolment - age 4 years HIV-exposed Not on CTX On CTX PY= person-years of follow-up. PPY=Per person-year of follow-up. IRR= incidence rate ratio. CTX=cotrimoxazole. BF=breastfeeding. Incidence rate ratio with 95% confidence interval, controlling for place of residence and antimalarial treatment arm † For randomised groups, incidence is from cessation of breastfeeding to 2 years of age. For observational cohorts, incidence is from enrolment (6 weeks-12 months of age) to 2 years of age. Observational cohorts, not randomised. 2 Appendix Homsy et al. - Protective efficacy of prolonged cotrimoxazole prophylaxis against malaria in Ugandan children up to age 4 years Table C1. Incidence of diarrheal episodes among HIV-exposed children according to cotrimoxazole (CTX) randomisations and age ranges Incidence HIV status CTX prophylaxis status Episodes PY IRR (95% CI) p-value PPY Enrolment – end of BF HIV exposed On CTX 359 105.5 3.40 128 158 86.9 104.1 1.47 1.52 Reference group 1.05 (0.78-1.40) 0.75 Before age 2 years† HIV exposed HIV exposed Randomised to stop CTX Randomised to continue CTX Between age 2 years and 4 years HIV exposed CTX stopped after cessation of BF 89 151.2 0.59 Reference group - HIV exposed CTX stopped at 2 years of age 36 89.9 0.40 0.71 (0.41-1.24) 0.22 HIV exposed Randomised to continue CTX 40 83.4 0.48 0.84 (0.49-1.46) 0.54 Between age 4 years and 5 years HIV exposed HIV exposed CTX stopped after cessation of BF CTX stopped at 2 years of age 28 14 69.7 42.4 0.40 0.33 Reference group 0.83 (0.35-1.98) 0.67 HIV exposed CTX stopped at 4 years of age 18 36.2 0.50 1.12 (0.48-2.63) 0.79 PY= person-years of follow-up. PPY=Per person-year of follow-up. IRR= incidence rate ratio. CTX=cotrimoxazole. BF=breastfeeding. Incidence rate ratio with 95% confidence interval (CI), controlling for place of residence and antimalarial treatment arm † For randomised groups, incidence is from cessation of breastfeeding to 2 years of age. For observational cohorts, incidence is from enrolment (6 weeks-12 months of age) to 2 years of age. 3 Appendix Homsy et al. - Protective efficacy of prolonged cotrimoxazole prophylaxis against malaria in Ugandan children up to age 4 years Table C2. Incidence of pneumonia among HIV-exposed children according to cotrimoxazole (CTX) randomisations and age ranges Incidence HIV status CTX prophylaxis status Episodes PY* IRR (95% CI) p-value PPY** Enrolment – end of BF HIV exposed On CTX 14 105.5 0.133 9 23 86.9 104.1 0.104 0.221 Reference group 2.14 (0.97-4.71) Before age 2 years† HIV exposed HIV exposed Randomised to stop CTX Randomised to continue CTX 0.06 Between age 2 years and 4 years HIV exposed HIV exposed CTX stopped after cessation of BFβ CTX stopped at 2 years of age 13 6 151.2 89.9 0.086 0.067 Reference group 0.78 (0.27-2.21) 0.64 HIV exposed Randomised to continue CTX 14 83.4 0.168 1.96 (0.83-4.66) 0.13 Between age 4 years and 5 years HIV exposed HIV exposed CTX stopped after cessation of BFβ CTX stopped at 2 years of age 5 6 69.7 42.4 0.072 0.142 Reference group 1.98 (0.53-7.47) 0.31 HIV exposed CTX stopped at 4 years of age 1 36.2 0.028 0.40 (0.04-3.75) 0.42 PY= person-years of follow-up. PPY=Per person-year of follow-up. IRR= incidence rate ratio. CTX=cotrimoxazole. BF=breastfeeding. Incidence rate ratio with 95% confidence interval (CI), controlling for place of residence and antimalarial treatment arm † For randomised groups, incidence is from cessation of breastfeeding to 2 years of age. For observational cohorts, incidence is from enrolment (6 weeks-12 months of age) to 2 years of age. 4
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