Background: Provision of anti-retroviral therapy (ART) for HIV-infected
children is complicated using syrup formulations, which are costlier
than tablets, harder to transport and store and difficult for
health-workers to prescribe and caregivers to administer.
Dispersible/crushable tablets may be more appropriate. We studied the
acceptability of syrups and scored tablets among young children who used
both in the AntiRetroviral Research fOr Watoto (ARROW) trial.
Methods: ARROW is an ongoing randomized trial of paediatric ART
monitoring and treatment strategies in 1206 children in Uganda and
Zimbabwe. 405 children initially received syrups of combination ART
including Nevirapine, Zidovudine, Abacavir and Lamivudine before
changing, when reaching the 12-,15 kg weightband, to scored adult-dose
tablets prescribed according to WHO weightband tables. Caregiver
expectations and experiences were collected in questionnaires at their
last visit on syrups and after 8 and 24 weeks on tablets.
Results: Questionnaires were completed by caregivers of 267 children
(median age 2.9 years (IQR 2.5, 3.4)). At last visit on syrups, 79%
caregivers reported problems with syrups, mostly related to number,
weight, transportation and conspicuousness of bottles. Difficulties
taking tablets were expected by 127 (48%) caregivers; however, after 8
and 24 weeks, only 26% and 18% reported their children had problems with
tablets and no problems were reported with
transportation/conspicuousness. Taste, swallowing or vomiting were
reported as problems ‘sometimes/often’ for 14%, 9%, 22% children on
syrups and 16%, 9%, 8% on tablets. At last visit on syrups, 74%
caregivers expected to prefer tablets but only 27% thought their child
would. After 8/24 weeks, 94%/97% caregivers preferred tablets and
57%/59% reported their child did.
Conclusions: Most children at about 3 years can take tablets; caregivers
and children themselves generally prefer tablets to liquid formulations
of HIV medications above this age. Preferences of caregivers and
children should be considered when designing and licensing paediatric
Cook, A.; Vhembo, T.; Opilo, W.; Namuddu, R.; Katuramu, R.; Tezikyabbiri, J.; Gibb, D. Young HIV-Infected Children and Their Adult Caregivers Prefer Tablets to Syrup Anti-retroviral Medications in Africa. PLoS ONE (2012) 7 (5) 8 pp.
Young HIV-Infected Children and Their Adult Caregivers Prefer Tablets to Syrup Anti-retroviral Medications in Africa