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Acceptability and Feasibility of Using Raltegravir Oral Granules for the Treatment of Neonates in a Low-resource
Moherndran Archary1,2, Brian Zanoni3, Marc Lallemant4,5
1From the Department of Paediatrics and Children Health, University of KwaZulu-Natal, Durban, South Africa.
Insights
Preparing raltegravir granules for oral suspension for infants with HIV can be challenging. However, with practice, caregivers in low-resource settings found the process feasible and acceptable, improving infant HIV treatment outcomes.
Area of Science:
- Pediatric Infectious Diseases
- Global Health Pharmacy
- HIV/AIDS Treatment
Background:
- Raltegravir granules for oral suspension are recommended by the World Health Organization for neonates with HIV.
- The multistep preparation process may pose challenges for caregivers.
Purpose of the Study:
- To evaluate the acceptability and feasibility of preparing raltegravir oral suspension.
- To assess caregiver and healthcare worker experiences in a low-to-middle-income country.
Main Methods:
- A study was conducted in Durban, South Africa, involving 34 caregivers and 10 healthcare workers.
- Healthcare workers trained caregivers using pictorial instructions and demonstration kits.
- Caregivers were evaluated during preparation, practiced at home, and were re-evaluated.
Main Results:
- Caregiver median preparation time decreased from 7.95 to 7.48 minutes with practice.
- Significant reduction in preparation errors observed (2.5 to 0.87, P = 0.023).
- Most participants initially found preparation difficult but gained confidence.
Conclusions:
- Raltegravir oral suspension preparation is acceptable and feasible for caregivers in low-resource settings with practice.
- This formulation's feasibility supports its inclusion in infant HIV treatment guidelines.
- The study highlights the importance of training and practice for complex medication preparation.
Background:
Raltegravir granules for oral suspension, now recommended by World Health Organization for use in neonates with HIV infection, may be challenging for caregivers because of the multistep preparation required.
Methods:
We evaluated the acceptability and feasibility of preparing granules for oral suspension in a low-to-middle-income country setting. Thirty-four caregivers and 10 health-care workers were enrolled from an HIV clinic in Durban, South Africa. Health-care workers were provided with pictorial instruction booklet, demonstration kit and guidance on preparation of granules for oral suspension. The health-care workers then trained caregivers on the preparation of granules for oral suspension. Caregivers were evaluated during the preparation process and instructed to practice at home with a sample kit and return to the clinic for repeat evaluation 5-7 days later. Caregivers and health-care workers were interviewed and participated in a focus group discussion regarding their experiences.
Results:
The median age of the caregivers was 31 years (interquartile range: 9.7); 70% had received secondary-level education, 37% were employed. The median preparation time was 7.95 minutes (interquartile range: 5.08 minutes) and 7.48 minutes (3.55 minutes) at initial and repeated observation, respectively. Major errors were insufficient mixing time and incorrect suspension volume. The average number of errors between the 2 observation time points was significantly reduced at the repeat session (2.5 vs. 0.87, P = 0.023). Most participants found the preparation difficult at first but gained confidence over time.
Conclusion:
Despite the complexity involved in the preparation of the granules for oral suspension, with practice, this formulation was found to be acceptable and feasible to majority of participants in this low-resource setting. As a result, this formulation was included in the 2018 World Health Organization recommendations for first line in neonates living with HIV.
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