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

Patricia Myung1, David Pugatch, Mark F Brady

  • 1Brown Medical School, Providence, RI, USA.

American Journal of Public Health
|April 28, 2007
PubMed

Insights

Directly observed antiretroviral therapy (ART) in Cambodia improved CD4 counts in HIV-infected children. This low-cost strategy, costing $5/child/month, ensures treatment adherence in resource-limited settings.

Area of Science:

  • Global Health
  • Pediatric Infectious Diseases
  • Public Health

Background:

  • Antiretroviral medications are increasingly accessible for children with HIV in resource-limited areas.
  • Ensuring treatment adherence is a significant challenge in these settings.

Purpose of the Study:

  • To evaluate the effectiveness and feasibility of directly observed antiretroviral therapy (DOART) for HIV-infected children in Phnom Penh, Cambodia.
  • To assess treatment outcomes, adherence, and cost-effectiveness of DOART.

Main Methods:

  • A cohort of 117 late-stage HIV-infected children received twice-daily generic antiretroviral drugs administered by child care workers.
  • Treatment adherence was ensured through direct observation.
  • Outcomes, including CD4 counts and drug toxicities, were monitored over at least six months.

Main Results:

  • Despite an initial mortality of 22 children in the first six months, the remaining children showed CD4 count increases comparable to those in developed countries.
  • Drug toxicities were infrequent and manageable.
  • Program staffing costs were approximately US $5 per child per month, representing a 15% increase over medication costs.

Conclusions:

  • Directly observed antiretroviral therapy is a viable and promising strategy for managing HIV in children within resource-limited environments.
  • DOART effectively improves adherence and clinical outcomes, offering a cost-effective solution.

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