Directly observed highly active antiretroviral therapy for HIV-infected children in Cambodia

Abstract

Antiretroviral medications are becoming available for HIV-infected children in resource-limited settings. Maryknoll, an international Catholic charity, provided directly observed antiretroviral therapy to HIV-infected children in Phnom Penh, Cambodia. Child care workers administered generic antiretroviral drugs twice daily to children, ensuring adherence. Treatment began with 117 late-stage HIV-infected children; 22 died of AIDS during the first 6 months. The rest were treated for at least 6 months and showed CD4 count increases comparable to those achieved in US and European children. Staffing cost for this program was approximately US $5 per child per month, or 15% more than the price of the medications. Drug toxicities were uncommon and easily managed. Directly observed antiretroviral therapy appears to be a promising, low-cost strategy for ensuring adherent treatment for HIV-infected children in a resource-limited setting.

FIGURE 1—

Flowchart of children receiving directly observed treatment with HAART from the Maryknoll Little Sprouts program: Phnom Penh, Cambodia, August 2002 to October 2004.

Figure 2

Child receiving directly observed treatment with highly active antiretroviral therapy. Source. Courtesy of John Tucker.