The provision of anti-retrovirals (ARVs) for children is complicated by
syrup formulations which in comparison to tablets are: more expensive,
harder to transport, harder to store, more difficult for carers to
administer, additional problems with syrups include palatability and
large volumes, which increase with age, as well as the lack of fixed
dose combinations so each agent must be administered separately.
Provided correct doses can be given, tablets are often more appropriate
for children in resource-limited settings. We studied the acceptability
of syrup and scored tablet ARVs dosed according to WHO weight bands
among children substituting syrups with tablets. ARROW is an on-going
randomised trial of paediatric ARV monitoring and treatment
strategies.1207 children aged 3 months to 17 years enrolled in
Uganda/Zimbabwe during 2007/08. At enrolment 34%(406/1207) children
received syrups of individual drugs (NNRTI + 2 or 3 of ZDV, ABC, 3TC).
Of those starting syrups, 58% (236/406) children substituted scored
tablets based on WHO weight band dosing tables between May 2008 and
December 2009. This was encouraged for children around 3 years of age
(according to WHO tables). At time of substitution, baseline
questionnaires were administered to carers to elicit their experience
with syrups and expectations of tablets. Eight weeks later, follow-up
questionnaires asked for their experience with tablets. A total of 79%
(186/236) of questionnaires from children changing formulation were
analysed: 17 children on tablets less than 8 weeks were excluded; 15 and
18 questionnaires were not completed at baseline or at follow-up
respectively. Median age of children at the time of change in
formulation was 2.9 years (IQR 2.4, 3.4). At baseline, 77% (144/186)
carers reported problems while using syrups, because of the number and
weight of bottles of liquid and bottles of liquid being difficult to
Ntege, P.N.; Dangarembizi, M.F.B.; Byaruhanga, J.; Cook, A.; Bakeera-Kitaka, S.; Keishanyu, R.; Mudzingwa, S.; Nabulime, G.; Kekitiinwa, A.; Spyer, M.; Nankya, F.; Nathoo, K.; Tezikyabbiri, J.; Kasirye, P.; Gibb, D.M. Tablets are more acceptable and give fewer problems than syrups among young HIV-infected children in resource-limited settings in the ARROW trial. Presented at 2nd International Workshop on HIV Paediatrics, 16 – 17 July 2010 and XVIII International AIDS Conference, 18 – 23 July 2010, Vienna, Austria. (2011) 1 pp.
Tablets are more acceptable and give fewer problems than syrups among young HIV-infected children in resource-limited settings in the ARROW trial.