34
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Young HIV-Infected Children and Their Adult Caregivers Prefer Tablets to Syrup Antiretroviral Medications in Africa

      research-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          Provision of anti-retroviral therapy (ART) for HIV-infected children is complicated using syrup formulations, which are costlier than tablets, harder to transport and store and difficult for health-workers to prescribe and caregivers to administer. Dispersible/crushable tablets may be more appropriate. We studied the acceptability of syrups and scored tablets among young children who used both in the AntiRetroviral Research fOr Watoto (ARROW) trial.

          Methods

          ARROW is an ongoing randomized trial of paediatric ART monitoring and treatment strategies in 1206 children in Uganda and Zimbabwe. 405 children initially received syrups of combination ART including Nevirapine, Zidovudine, Abacavir and Lamivudine before changing, when reaching the 12-<15 kg weightband, to scored adult-dose tablets prescribed according to WHO weightband tables. Caregiver expectations and experiences were collected in questionnaires at their last visit on syrups and after 8 and 24 weeks on tablets.

          Results

          Questionnaires were completed by caregivers of 267 children (median age 2.9 years (IQR 2.5, 3.4)). At last visit on syrups, 79% caregivers reported problems with syrups, mostly related to number, weight, transportation and conspicuousness of bottles. Difficulties taking tablets were expected by 127(48%) caregivers; however, after 8 and 24 weeks, only 26% and 18% reported their children had problems with tablets and no problems were reported with transportation/conspicuousness. Taste, swallowing or vomiting were reported as problems ‘sometimes/often’ for 14%, 9%, 22% children on syrups and 16%, 9%, 8% on tablets. At last visit on syrups, 74% caregivers expected to prefer tablets but only 27% thought their child would. After 8/24 weeks, 94%/97% caregivers preferred tablets and 57%/59% reported their child did.

          Conclusions

          Most children at about 3 years can take tablets; caregivers and children themselves generally prefer tablets to liquid formulations of HIV medications above this age. Preferences of caregivers and children should be considered when designing and licensing paediatric drug formulations.

          Related collections

          Most cited references26

          • Record: found
          • Abstract: found
          • Article: not found

          Adherence to highly active antiretroviral therapy assessed by pharmacy claims predicts survival in HIV-infected South African adults.

          It is unclear how adherence to highly active antiretroviral therapy (HAART) may best be monitored in large HIV programs in sub-Saharan Africa where it is being scaled up. We aimed to evaluate the association between HAART adherence, as estimated by pharmacy claims, and survival in HIV-1-infected South African adults enrolled in a private-sector AIDS management program. Of the 6288 patients who began HAART between January 1999 and August 2004, 3805 (61%) were female and 6094 (97%) were black African. HAART adherence was >or=80% for 3298 patients (52%) and 100% for 1916 patients (30%). Women were significantly more likely to have adherence>or=80% than men (54% vs 49%, P 200 cells/microL). Pharmacy-based records may be a simple and effective population-level tool for monitoring adherence as HAART programs in Africa are scaled up.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Minitablets: new modality to deliver medicines to preschool-aged children.

            The goal was to assess the acceptability and suitability of placebo minitablets for preschool-aged children. One hundred children 2 to 6 years of age were recruited from a major London hospital. How to swallow the minitablet was discussed with the child, and chewing was discouraged. The parents were asked to administer 1 minitablet (placebo, 3-mm diameter) to the child. The outcomes were recorded as (1) swallowed, (2) chewed, (3) spat out, or (4) refused to take. Of the youngest children (2 years of age), almost one half (46%) swallowed the minitablet. The proportion increased to 53% for children 3 years of age. Children > or =4 years of age were more likely to swallow the minitablet than not to swallow the minitablet, with 85% of 5-year-old children swallowing the minitablet. The ability to swallow the minitablet was not affected by gender. This study demonstrated the potential to use minitablets for the treatment of preschool-aged children and suggests that minitablets can be used as a potential new formulation for children in this age range.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Efficacy of a pill-swallowing training intervention to improve antiretroviral medication adherence in pediatric patients with HIV/AIDS.

              We aimed to retrospectively assess the efficacy of pill-swallowing training provided as a clinical intervention to referred pediatric patients with HIV in relation to improved adherence and subsequent related health outcomes. The primary goal of this study was to demonstrate participation in pill-swallowing training is associated with improved medication adherence as documented by routine pharmacy pill counts. Secondary objectives were to assess corresponding improvements in clinically observed biologic indicators of adherence, specifically, immunologic functioning (CD4+ T-cell%) and viral load, over time. A retrospective chart review of 23 pediatric patients with HIV aged 4 to 21 years who were clinically referred for pill-swallowing training by an experienced pediatric psychologist for either noted difficulties with currently prescribed antiretroviral regimens and/or desire to change the child's regimen/formulary. Patient demographics, reason(s) for pill-swallowing training referral, number of pill-swallowing training sessions required to attain success, adherence, CD4+ T-cell%, and viral load were abstracted at baseline and at approximately 3 and 6 months posttraining. Modal number of sessions required to acquire the pill-swallowing skill was 1 session. Younger children (aged 4-5 years) required a median of 2 training sessions, while older children required > or = 3 sessions. A significant improvement in adherence from baseline to 6 months post-pill-swallowing training completion was observed, as were significant related improvements in CD4+ T-cell% and viral load. Participation in pill-swallowing training related to improved medication adherence at 6 months posttraining. Subsequent improvements in related CD4+ T-cell% and viral load were noted over time, most significantly at 6 months postintervention. These preliminary findings provide justification for additional study via a prospective, randomized, controlled clinical trial. Pill-swallowing training potentially is a successful time-limited, cost-effective intervention to improve adherence to antiretroviral therapies, and thus medical status, in children with HIV.
                Bookmark

                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2012
                2 May 2012
                : 7
                : 5
                : e36186
                Affiliations
                [1 ]MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
                [2 ]MRC Clinical Trials Unit, London, United Kingdom
                [3 ]University of Zimbabwe Medical School, Harare, Zimbabwe
                [4 ]Joint Clinical Research Centre, Kampala, Uganda
                [5 ]Baylor-Uganda Paediatric Infectious Disease Clinic, Mulago Hospital, Kampala, Uganda
                University of Ottawa, Canada
                Author notes

                Analyzed the data: AC. Wrote the paper: PNN AC TV RK RN WO JT BN DG.

                Article
                PONE-D-12-00661
                10.1371/journal.pone.0036186
                3342167
                22567139
                e2c2bd64-d9f5-44ef-839b-eeefd333dd1f
                Nahirya-Ntege et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
                History
                : 4 January 2012
                : 2 April 2012
                Page count
                Pages: 8
                Categories
                Research Article
                Biology
                Microbiology
                Virology
                Antivirals
                Medicine
                Clinical Research Design
                Survey Research
                Drugs and Devices
                Drug Research and Development
                Drug Licensing and Regulation
                Epidemiology
                Pediatric Epidemiology
                Global Health
                Infectious Diseases
                Viral Diseases
                HIV
                HIV diagnosis and management
                HIV epidemiology
                Pediatrics

                Uncategorized
                Uncategorized

                Comments

                Comment on this article