Case Study No. 8. Tablets are more acceptable and give fewer problems than syrups among young HIV-infected children in resource-limited settings in the ARROW trial
The provision of anti-retrovirals (ARVs) for children is complicated by syrup formulations, which have a number of important limitations. Children are often treated with partial adult tablets, which are crushed and given with food or liquid, a practice that can result in inaccurate dosing. Syrups are usually more expensive than tablets, harder to transport and store which makes confidentiality difficult to maintain; and difficult for carers to administer. Therefore, provided correct doses can be given, tablets are often more appropriate for children in resourcelimited settings. The ARROW trial studied the acceptability of syrups and scored tablets (ARVs) as a substudy among children substituting syrups with tablets. ARROW (www.arrowtrial.org), which commenced in March 2007, is an ongoing 5 year open label randomised clinical trial in 1207 HIV infected children in Uganda and Zimbabwe, investigating monitoring practice and first line antiretroviral therapy strategies. This sub-study within ARROW highlighted that scored tablets compared to syrups can be used in young children with few problems, and also that most children and their carers prefer them. It identified that fewer difficulties were expected and much less experienced with the use of tablets. Furthermore, a pharmacokinetic study showed that these tablets (dosed according to WHO weight band tables) provided correct plasma drug levels for children.
Evidence For Action Case Study No. 08 July 2010, 2 pp.