Development of Model ART Services to Children

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Development of Model ART Services to Children

Project Report Submitted for Fulfillment of Fellowship in HIV

Medicine. Dr.Lathika Nayar, Senior Lecturer,Dept of Peadiatrics

Medical College, Thrissur, Kerala

ABSTRACT

HIV pandemic is on the rise affecting all age groups. Newer

treatment options have brought out more cases. ART though not a cure

does reduce the morbidity and mortality. But the efficacy of ART is

largely dependent on the adherence to ART. Lack of paediatric

preparations and the role of caregivers affect adherence in children.

The project was conducted at the Dept of Paediatrics, Medical

college, Thrissur, Kerala.. The aim of the project was to develop

model ART services to children and to assess and ensure adherence in

them. It has along term goal of assessing the adverse effects of ART

which requires more follow up.

To achieve the objectives clinical and adherence record sheet were

developed. All HIV positive children were registered and clinical

record sheets filled. To aid the process of adherence assessment we

used calendar method and pill count method. A calendar with a

pillbox was designed for the same. We developed child friendly

education material on issues related to adherence and health

promoting practices. We also conducted caregivers' meeting to

increase their awareness.

Adherence levels of 19 children were assessed at entry point in the

project and then during every follow up. The adherence level in this

population were more than 95% in >95% patients as far as missed

doses were concerned. With respect to correct timings adherence

increased from 58% to100% with the above methods.

Repeated counseling with emphasis on correct dosage and timings,

providing already cut tablets (especially if it is ½ tablet twice a

day) resulted in substantial improvement in these parameters.

Adherence to ART in pediatric population is a complex issue. Factors

like poor motivation of care provider, complex regimens, multiple

pills, inability of care provider to understand the complex regimen,

stigma and discrimination from family members, inability to procure

medicines because of financial constraints, busy schedule etc

affected the adherence adversely. Care providers motivation was the

single most important factor associated with good adherence.

Involving the child in care right from the beginning has

definite advantages. There is an urgent need for paediatric

formulations.

A comprehensive model involving clinician, counselor, care provider

and patient will help in providing comprehensive ART services to

children.

Full text of the report is available at:

http://www.fhmindia.org/downloads/development_of_model_art_services.p

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