Clinically-driven monitoring of children on ART is safe and may increase access to treatment

Abstract

The evidence from ARROW (and other studies of paediatric antiretroviral therapy (ART)) shows that children respond very well to treatment and have few side effects. This policy brief examines the issues around two related factors that may act as barriers to treatment for children: healthcare workers nervousness about putting children onto ART because of worries about side effects to the medicines; and the perceived need for routine laboratory monitoring of children on ART (both for side-effects and effectiveness). Key findings: • Access to HIV treatment for children is lagging behind that of adults – by the end of 2011 only 28% of children who needed treatment were on it (compared with 58% of adults) • The perception that routine laboratory monitoring is needed for children on antiretroviral therapy may be a barrier to increasing access to life-saving treatment • Once children are stable on HIV treatment they do very well, with low death rates, little need for switching and excellent CD4 responses and viral load suppression several years after starting treatment • HIV treatment can be delivered safely to children with good quality clinical care, without any need for routine laboratory tests for side effects of ARV medicines • Routine CD4 monitoring provided only a very small and late benefit mainly in older children. There was no difference in viral load suppression with routine CD4 monitoring compared with clinically-driven monitoring alone • Monitoring weight-gain in children appeared to be useful in picking up failure of first-line treatment early • Treatment programmes should focus on increasing children’s access to HIV treatment, rather than spending resources on expensive laboratory tests that provide limited benefit

Citation

South, A.; Bwakura-Dangarembizi, M.; Cook, A.; Crawley, J.; Kekitiinwa, A.; Munderi, P.; Prendergast, A.; Walker, S.; Gibb, D. M. MRC CTU Briefing Paper March 2013 Issue 6. (2013)

Clinically-driven monitoring of children on ART is safe and may increase access to treatment

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