Tablets are more acceptable and give fewer problems than syrups among young HIV-infected children in resource-limited settings in the ARROW trial.

Abstract

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 transport.

Citation

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.

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