312 Policy & practice Bull World Health Organ 2011;89:312–316 | doi:10.2471/BLT.10.077743 Introduction In recent years, three separate papers in leading medical journals have raised the question of why co-trimoxazole prophylaxis for opportunistic infections in patients living with the human im- munodeiciency virus (HIV) has not been more widely scaled up in low-income countries. Published in he Lancet Infectious Diseases, 1 the BMJ 2 and the Bulletin of the World Health Orga- nization, 3 these papers have all expressed the authors’ frustration at knowing that an intervention known to be highly eicacious, cost-efective, amply researched and urgently needed has not become widely available, especially in Africa. In the most recent article, Date et al. combined analyses of the development of policy on co-trimoxazole prophylaxis and on isoniazid preventive therapy to raise concerns about the uptake of both interven- tions. While operationally the need to rule out active disease before initiating treatment creates problems that make isoniazid preventive therapy especially challenging, Date et al. highlight similarities in the frustration generated by the slow scale-up of both co-trimoxazole prophylaxis and isoniazid preventive therapy. hey point out that at the national level both the de- velopment of co-trimoxazole prophylaxis and the development and implementation of policy on isoniazid preventive therapy have been sluggish, and they argue that “strong advocacy and dis- semination of evidence-based information regarding the beneits of co-trimoxazole prophylaxis and isoniazid preventive therapy are urgently required at the national and international level”. Several eforts have been made internationally to improve the way in which research evidence is conveyed to health policy- makers and to advocate for the bridging of the gap evidence and policy. he Evidence Informed Policy Network launched by the World Health Organization (WHO), is example of an entity whose purpose is to promote these fu tions (www.who.int/rpc/evipnet/en/). However, advocacy a dissemination can only go so far in inluencing policy chang and implementation in practice. As Date et al. explain, evi based data on the beneits of both co-trimoxazole prophyla and isoniazid preventive therapy has not been lacking inte tionally. he indings from the irst studies conducted on co- trimoxazole prophylaxis were published in the Lancet as e as 1999 4,5 and subsequent studies showed that co-trimoxazo prophylaxis was beneicial in adults and children in are high resistance to co-trimoxazole 6–8 , as well as in adults on anti- retroviral therapy (ART). 9 Research on the eicacy of isoniazid preventive therapy began even earlier and has already be subject of three Cochrane reviews. 10–12 Beyond these research indings, the Joint United Nations Programme on HIV/AIDS, WHO and the United Nations Children’s Fund have all issue guidelines on the use of co-trimoxazole prophylaxis on diferent occasions, 13–15 while isoniazid preventive therapy was the subject of WHO recommendations irst published in 199 and later reairmed by the Stop TB partnership in 2007 and 2011. 16–18 In these examples, research indings were available and many cases had been clearly disseminated or advocated f the research and international public health communities. who feel frustrated by the lack of uptake of research resul the apparent stalling of policy development must understa Abstracts in يرع, 中文 , Français, Pусский and Español at the end of each article. Abstract In the April 2010 issue of this journal, Date et al. expressed concern over the slow scale-up in low- two therapies for the prevention of opportunistic infections in people living with the human immunodeicien prophylaxis and isoniazid preventive therapy. This short paper discusses the important ways in which polic understanding and explaining how and why certain evidence makes its way into policy and practice and w this process. Key lessons about policy development are drawn from the research evidence on co-trimoxazo lessons may prove helpful to those who seek to inluence the development of national policy on isoniazid pr treatments. Researchers are encouraged to disseminate their indings in a manner that is clear, but they m how structural, institutional and political factors shape policy development and implementation. Doing so w and address the concerns raised by Date et al. and other experts. Mainstreaming policy analysis approach factors shape the uptake of research evidence can provide an additional tool for researchers who feel frust indings have not made their way into policy and practice. Translating evidence into policy in low-income countries: lessons from co-trimoxazole preventive therapy Eleanor Hutchinson, a Benson Droti, b Diana Gibb, c Nathaniel Chishinga, d Susan Hoskins, c Sam Phiri e & Justin Parkhurst f a Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, London, WC b Medical Research Council Uganda Virus Research Institute, Research Unit on AIDS in Uganda, Entebbe, Uganda. c Medical Research Council Clinical Trials Unit, London, England. d Zambia AIDS Related TB Project, Lusaka, Zambia. e Lighthouse Trust, Lilongwe, Malawi. f London School of Hygiene and Tropical Medicine, London, England. Correspondence to Eleanor Hutchinson (e-mail: eleanor.hutchinson@lshtm.ac.uk). (Submitted: 31 March 2010 – Revised version received: 31 January 2011 – Accepted: 1 February 2011 – Published online: 28 February Policy & practice