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AJPH First Look, published online ahead of print Apr 26, 2007
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June 2007, Vol 97, No. 6 | American Journal of Public Health 974-977
© 2007 American Public Health Association
DOI: 10.2105/AJPH.2005.083253

FIELD ACTION REPORT

Directly Observed Highly Active Antiretroviral Therapy for HIV-Infected Children in Cambodia

Patricia Myung, MD, David Pugatch, MD, Mark F. Brady, BS, Phok Many, Joseph I. Harwell, MD, Mark Lurie, PhD and John Tucker

At the time of the study, David Pugatch, Mark Lurie, and Joseph I. Harwell were with Brown Medical School, Providence, RI. Mark F. Brady and Patricia Myung were students at Brown Medical School, Providence. Phok Many and John Tucker were with the Maryknoll Little Sprouts program, Phnom Penh, Cambodia.

Correspondence: Requests for reprints should be sent to David Pugatch, Division of Pediatric Infectious Diseases, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (e-mail: DPugatch{at}lifespan.org).

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.




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