Children on HIV treatment need to take three

Adherence

Children on HIV treatment need to take three or more types of ARVs every day for the rest of their lives. If drugs are not taken routinely at around the same time every day, HIV may become resistant to the therapy, causing it to stop working.

A review of 17 studies regarding paediatric HIV treatment adherence found adherence ranging from 49% to 100%.³³ Three-quarters of the studies showed adherence rates of 75%. Most of the studies in lower and middle-income countries revealed adherence rates above 75%, whereas adherence in higher-income countries was generally below 75%. However, there are variations in treatment adherence across and even within countries. Socioeconomic status of the child, whether or not a child's status has been disclosed or not, and user fees are some of the factors that can contribute to low treatment adherence levels amongst children.^{34 35}

Many factors can lead to adherence problems: inadequate dosing; high pill burden; reluctance among young infants to take syrups and powders due to their unpleasant taste; dietary restrictions; and toxic side effects of drugs. Adherence issues can put an enormous strain on the daily lives of parents and caregivers, who are usually responsible for administering treatment. Some ARVs need to be taken with food, so carers may have to perform the often difficult task of providing a meal and administering drugs simultaneously. This is assuming that an adequate supply of food is actually available. If fixed-dose combinations appropriate for use in children became more widely available, it is likely that adherence would generally improve, since it is much easier to take a single dose every day rather than multiple doses.