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. 2022 Jul;6(1):e001474.
doi: 10.1136/bmjpo-2022-001474.

Optimising neonatal antiretroviral therapy using raltegravir: a qualitative analysis of healthcare workers' and caregivers' perspectives

Leila Katirayi  1 , Carl Stecker  2 , Precious Andifasi  3 , Angela Mushavi  3 , Pradisha Tiwari  4 , Chioniso Jakazi  5 , Talent Maphosa  6 , Viva Thorsen  7 , Mildrate Murandu  8 , Gladys Gombakomba  9 , More Mungati  9 , Lise Denoeud-Ndam  10 , Emilia Rivadeneira  7 , Rachel Weber  6 , Susan Hrapcak  7
Affiliations

Optimising neonatal antiretroviral therapy using raltegravir: a qualitative analysis of healthcare workers' and caregivers' perspectives

Leila Katirayi et al. BMJ Paediatr Open. 2022 Jul.

Abstract

Background: In 2020, Zimbabwe adopted the WHO's recommendation to use raltegravir (RAL) granule-based regimens for treatment of neonates identified with HIV at the time of birth testing. This study explores the acceptability of RAL granules by caregivers and healthcare workers (HCWs).

Methods: Interviews were conducted with 15 caregivers and 12 HCWs from 8 health facilities in Zimbabwe participating in the introductory pilot of RAL granules treatment for newborns. Eligible caregivers included those who had administered RAL to their infant and attended either 8th or 28th day of life appointments. Caregivers of neonates recently initiated on RAL were selected through convenience sampling. Eligible HCWs who provided RAL preparation, administration instructions and support to caregivers of neonates on RAL for at least 3 months were recruited from the same facilities as the caregivers. Interview transcripts were coded and thematically analysed.

Results: Caregivers reported that their babies looked healthier after RAL initiation, with improved skin appearance and weight gain. Some caregivers wanted their child to remain on RAL beyond 28 days instead of switching regimens, as recommended by national guidelines. HCWs observed that RAL granules improved health outcomes compared with other regimens. HCWs reported challenges with caregivers understanding dosing instructions, measuring with a syringe, swirling and not shaking the medicine, discarding unused medication and following the changes in the dosing schedule and amount when RAL was initiated a few days after birth. HCWs stated that adequate counselling and repeat demonstrations were crucial to ensure that caregivers clearly understood RAL dosing and administration instructions. HCWs requested more standardised training targeting nurses with guidance on handling missed doses and clarification on mixing RAL granules with water and not breastmilk.

Conclusion: While feedback from caregivers and HCWs on RAL implementation was positive, barriers were also noted. Adequate training and sufficient instruction and support for caregivers would help to ensure that RAL granules are prepared, dosed and administered correctly.

Keywords: HIV; neonatology; qualitative research.

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Conflict of interest statement

Competing interests: No, there are no competing interests.

References

    1. World Health Organization (WHO) . Global guidance on criteria and processes for validation: elimination of mother-to-child transmission of HIV and syphilis, second edition, 2017. Available: https://www.paho.org/en/node/21360 [Accessed 8 Jan 2022].
    1. Zimbabwe Ministry of Health and Child Care (MOHCC) . Report on HIV antenatal clinic surveillance using PMTCT program data with additional quality monitoring and strengthening in Zimbabwe. Harare, Zimbabwe: Ministry of Health and Child Care; 2017. [Accessed 11 Jan 2022].
    1. Zimbabwe MOHCC . National and sub-national HIV estimates report. Harare, Zimbabwe: AIDS & TB Programme, Ministry of Health and Child Care; 2021. [Accessed 11 Jan 2022].
    1. WHO . Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV: supplement to the 2016 consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Available: https://www.who.int/publications/i/item/WHO-CDS-HIV-18.51 [Accessed 27 Jan 2022].
    1. WHO . HIV drug resistance report 2021, 2021. Available: https://www.who.int/publications/i/item/9789240038608 [Accessed 27 Jan 2022].

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