Ensuring adherence to anti-retroviral therapy among children in resource constrained settings: lessons from Cambodia

  • Srinvasan P
  • Tucker J
  • Phok M
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Abstract

Issues: Effective pediatric HIV management requires continued access and sufficient adherence to ART as well as considerable social support services. Ensuring adherence in HIV positive children is particularly difficult in Cambodia because complex drug regimens must be properly administered twice daily at home by diverse, uninformed caregivers. Description: Social workers administered a written survey to four hundred caregivers of children living with HIV/AIDS across five Cambodian provinces. Caregivers were asked why they forgot to administer (or improperly administered) ART, educational attainment and health of the caregiver, household income, presence of opportunistic infections, knowledge of HIV and its causes, and HIV related stigma in the community. Lessons learned: Most (81%) caregivers giving their children ART on a regular basis report no difficulties properly administering the medication. The remaining 19%, however, report confusion over giving ART, missing dosages entirely, or difficulty remembering to give medications. Caregivers emphasize that confusion over how to give the medications is more common than missing dosages entirely, and all complications tended to occur in the first days and weeks of treatment. As many medications are in liquid form, and require measurement with a scaled syringe, caregivers often encountered difficulty preparing the proper dosage. Furthermore, several different types of medication are required per administration. While all caregivers are given instructional sessions on how to administer the drugs, these initial hospital consultations may be inadequate or insufficient. Next steps: High pediatric ART adherence is possible in resource-constrained settings like Cambodia. The most significant hurdles occur at the start of treatment, as caregivers are just beginning to understand how to properly administer medications. A modified, short-course directly administered anti-retroviral therapy (DAART) approach is an attractive option in the first few weeks to one month of treatment as social workers can visit caregivers twice-daily in their homes and demonstrate how to properly administer medications.

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APA

Srinvasan, P., Tucker, J., & Phok, M. (2008). Ensuring adherence to anti-retroviral therapy among children in resource constrained settings: lessons from Cambodia. XVII International AIDS Conference. 3-8 August 2008, Mexico City, Mexico. <br>Presenting author email: priya01@stanford.edu: XVII International AIDS Conference. 3-8 August 2008, Mexico City, Mexico.

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