OVC Support Toolkit  >  Health and nutrition  >  Children Living with HIV/AIDS 

Practical Treatment Tips

This section looks at ways in which children with HIV can be assisted to take their antiretroviral drugs and other medicines properly. Other sections cover issues regarding access to treatment and provide which antiretroviral drugs to use.

Key points about treatment with antiretroviral drugs in children in practice are:

1. If many drugs are to work properly they need to be taken regularly and in certain ways. This is particularly important for antiretroviral drugs. Taking drugs in the required way is called 'adherence' or 'compliance'.

2. There are many reasons why people fail to adhere to the treatment schedules.

3. There are a number of practical ways in which children can be helped to adhere to treatment schedules.

4. In addition to their medicines, sick children and adults require a great deal of care and comfort. Much of this is provided by family members in the home.

General Issues

This section focuses on practical issues relating to giving antiretroviral drugs to children. However, many of the issues raised here also apply to giving other medicines to children, such as tuberculosis drugs. There are also particular issues relating to giving medicines to older children/young people. These are not covered in detail in this section.

Some of the issues relating to antiretroviral drugs that are mentioned do not apply to their use in children only. They would also apply to their use in adults.

Why is Treatment Adherence so Important?

If antiretroviral drugs are to work properly they need to be taken regularly and in certain ways. Taking drugs in the required way is called 'adherence' or 'compliance'.

Problems with Taking Antiretroviral Medicines

There are many reasons why people fail to adhere to the treatment schedules. These include:

• Some medicines, such as Stavudine, Didanosine and Ritonavir need to be stored in a refrigerator.
• Some medicines need to be taken on an empty stomach. This means taking them either one hour before food or two hours after. These include Indinavir and Didanosine. In addition, these two drugs need to be taken one hour apart from each other. Some medicines need to be taken with food. These include Nelfinavir, Saquianvir and Lopinavir.
• Some medicines interact with each other. One may stop the other from working. They may also make side-effects more likely.
• Some medicines taste bad. Their taste can be improved by mixing with food, such as milk. Examples include Nelfinavir and Ritonavir.
• Some capsules are very large and difficult to swallow.
• It is difficult to remember to take a medicine several times a day every day. It may be difficult to fit this into schedules, such as going to school. Children may not wish to take medicines in public.
• Some medicines cause side-effects which make the child feel ill. They may not wish to take the medicine for this reason.
• It is difficult to calculate dosages based on surface area. It is easier to use weight. Dosages need to be increased as the child grows.

Some projects have lists of questions that adults can answer to check that a child is taking their medicines correctly.

Practical Ways of Improving Adherence

There are several practical ways of helping a child stick to their treatment schedule. These include:

• Producing a schedule for taking all the medicines. This should fit in with the family's schedule, including mealtimes.
• Finding ways of reminding children and their care givers when doses are due. This may include sticking the schedule somewhere that it can be easily seen. Alarm clocks and watches can be used to remind when doses are due.
• Having a way of recording when each dose has been given. This may include a version of the schedule with boxes that can be ticked.
• Coloured bottles to show which medicine is which.
• Special dosing cups, measuring spoons or oral syringes to help ensure that the right dose is given.
• Packing drugs into packages sufficient for one week. It is then possible to check at the end of the week that all medicines have been taken.
• Being positive and encouraging in dealing with the child.
• Ensuring that an adult is involved with the child in taking the medicine. This is particularly important for measuring the amount to be taken by small children. Adults should also check that children have swallowed the medicine they have been given.
• Finding ways of improving the taste of some medicines. This may include mixing the medicine with something or taking something with a better taste after the medicine. Chilling a medicine may make it taste better.
• Involving the child/young person in taking their own medicines. This is particularly important as the child gets older.
• Using medicines which can be given once per day rather than those that have to be given more often.
• Using dosage tables which show how to calculate the dosage of medicines from the weight of the child.
• Discussing any possible side-effects of the medicines with health staff.
• Informing health staff of any problems in taking the medicines. This includes informing them of any missed doses.

Other Elements of Treatment and Care

In addition to their antiretroviral medicines, children and adults who are sick as a result of HIV require other treatment and a great deal of care and comfort. Much of this is provided by family members in the home. Elements of this include:

• Taking to a clinic for treatment of common diseases, such as diarrhoea and other infections, and treatment of common symptoms, such as pain
• Buying medicines and assisting the person to take them
• Listening, talking and touching
• Dealing with past concerns
• Planning for the future
• Providing water and food
• Washing
• Changing the person's position in bed. Rubbing Vaseline on the skin
• Encouraging rest and exercise
• Avoiding getting or spreading any infections

• Send to a friend
• Printer-friendly
• Introductions to themes (pdf)