Directly Observed Therapy For HIV-Infected Children
Source:
Directly Observed Highly Active Antiretroviral Therapy for HIV-Infected Children in Cambodia Patricia Myung, David Pugatch, Mark F. Brady, Phok Many, Joseph I. Harwell, Mark Lurie, John Tucker Am J Public Health. 2007 Jun;97(6):974-7. Epub 2007 Apr 26.
Directly Observed Therapy
While Directly Observed Therapy is typically associated with the treatment of tuberculosis and is often viewed as expensive and draconian, this study of suggests that those stereotypes may be inaccurate and may unnecessarily restrict its implementation.
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.
Commentary
While the vital information is contained in the abstract, it may be helpful to think of the statistics for these children in these terms:
- T helper cells tripled
- Children gained weight
- Drug toxicities were rare and easily managed
- The annual cost per child broke down to $400 for medications; $60 to pay the professionals who administered the drugs
This preliminary study does not prove the value of the program. As the authors point out, a randomized, controlled trial comparing Directly Observed Therapy with standard care is necessary, as is a cost-benefit analysis
The study does, however, lend support to the notion that Directly Observed Therapy could prevent some cases of drug resistance and reduce the number of treatment failures and the number of cases requiring a shift to less efficient alternative therapies - an extraordinarily encouraging prospect.
AlignMap Blog Hiatus: Summer 2007 »
Related Posts:
