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About the Authors:
Ciara E. O’Reilly
* E-mail: [email protected]
Affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Ethel V. Taylor
Affiliations Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Tracy Ayers
Affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Ribka Fantu
Affiliation: Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
Sisay Alemayehu Abayneh
Affiliation: Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
Barbara Marston
Affiliation: Division of Global HIV/AIDS, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Yordanos B. Molla
Affiliation: Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
Tegene Sewnet
Affiliation: Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
Fitsum Abebe
Affiliation: Michael Dejene Public Health Consultancy Services, Addis Ababa, Ethiopia
Robert M. Hoekstra
Affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Robert Quick
Affiliation: Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Introduction
Diarrhea and other opportunistic infections are important causes of morbidity and mortality among people living with HIV/AIDS (PLHIV) [1]–[5]. Inexpensive interventions to prevent opportunistic infections in resource-poor settings can improve clinical outcomes in PLHIV [5]–[11] and may help reduce viral loads and maintain CD4+ cell counts (CD4 counts) [12]–[15]. Consequently, the US President’s Emergency Plan for AIDS Relief (PEPFAR) now authorizes use of program funds to procure and distribute proven health interventions (e.g., insecticide treated bednets, condoms, household water treatment products, soap) as part of HIV care and support programs [16].
Among the interventions shown to reduce the risk of diarrhea in PLHIV is household water treatment using a locally produced sodium hypochlorite solution and safe water storage using a narrow-mouth container with tap [5], [7]. In Ethiopia, two water treatment products for home chlorination are available: sodium hypochlorite solution with the brand name Wuha Agar, which is marketed at a price of USD 0.24 for a bottle that...