A 4-pronged approach to addressing antiretroviral adherence in children: a paediatric pharmacy perspective

  • Shenaaz Raiman
  • Desiree Michaels
  • James Nuttall
  • Brian Eley

Abstract

Providing highly active antiretroviral therapy (HAART) to children is more complex and challenging than is the case with adults. The pharmacy role includes ensuring good adherence in order to obtain the optimal clinical outcome. Some of the challenges in children include difficult-to-use drug formulations, frequent dosage adjustments based on body weight changes, and reliance on sometimes inconsistent care giving. To improve the care of HIV-infected children, the existing Department of Health guidelines for managing infected adults with HAART were adapted to the paediatric setting. A 4-pronged system was developed, which targeted each caregiver/healthcare professional contact point and incorporated the following interventions: (1) improved caregiver counselling through the use of a paediatric caregiver-specific booklet in English, isiXhosa and Afrikaans, (2) streamlining the clinician’s prescribing methods through simplification of treatment protocols, (3) pharmacy dispensing interventions, including standardised colour coding of medicines, drug dispensing techniques, dissolving and dispersing methods and coherent communication between pharmacist and caregiver, and (4) a structured follow-up of patient adherence through strict assessment of returns, HAART prescriptions and clinic attendance.

Author Biographies

Shenaaz Raiman
Main Pharmacy, Red Cross Children’s Hospital, Cape Town Paediatric Infectious Diseases Unit, Red Cross Children’s Hospital, School of Child and Adolescent Health, University of Cape Town
Desiree Michaels
Paediatric Infectious Diseases Unit, Red Cross Children’s Hospital, School of Child and Adolescent Health, University of Cape Town
James Nuttall
Paediatric Infectious Diseases Unit, Red Cross Children’s Hospital, School of Child and Adolescent Health, University of Cape Town
Brian Eley
Paediatric Infectious Diseases Unit, Red Cross Children’s Hospital, School of Child and Adolescent Health, University of Cape Town
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