title: Young HIV-infected children and their adult caregivers prefer tablets to syrup antiretroviral medications in Africa.
abstract: BACKGROUND
  Provision of anti-retroviral therapy (ART) for HIV-infected children is complicated using syrup formulations, which are costlier than tablets, harder to transport and store and difficult for health-workers to prescribe and caregivers to administer. Dispersible/crushable tablets may be more appropriate. We studied the acceptability of syrups and scored tablets among young children who used both in the AntiRetroviral Research fOr Watoto (ARROW) trial.
  
  
  METHODS
  ARROW is an ongoing randomized trial of paediatric ART monitoring and treatment strategies in 1206 children in Uganda and Zimbabwe. 405 children initially received syrups of combination ART including Nevirapine, Zidovudine, Abacavir and Lamivudine before changing, when reaching the 12-<15 kg weightband, to scored adult-dose tablets prescribed according to WHO weightband tables. Caregiver expectations and experiences were collected in questionnaires at their last visit on syrups and after 8 and 24 weeks on tablets.
  
  
  RESULTS
  Questionnaires were completed by caregivers of 267 children (median age 2.9 years (IQR 2.5, 3.4)). At last visit on syrups, 79% caregivers reported problems with syrups, mostly related to number, weight, transportation and conspicuousness of bottles. Difficulties taking tablets were expected by 127(48%) caregivers; however, after 8 and 24 weeks, only 26% and 18% reported their children had problems with tablets and no problems were reported with transportation/conspicuousness. Taste, swallowing or vomiting were reported as problems 'sometimes/often' for 14%, 9%, 22% children on syrups and 16%, 9%, 8% on tablets. At last visit on syrups, 74% caregivers expected to prefer tablets but only 27% thought their child would. After 8/24 weeks, 94%/97% caregivers preferred tablets and 57%/59% reported their child did.
  
  
  CONCLUSIONS
  Most children at about 3 years can take tablets; caregivers and children themselves generally prefer tablets to liquid formulations of HIV medications above this age. Preferences of caregivers and children should be considered when designing and licensing paediatric drug formulations.
authors.affiliation: MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
authors.forename: Patricia
authors.initials: P
authors.lastname: Nahirya-Ntege
authors.forename: Adrian
authors.initials: A
authors.lastname: Cook
authors.forename: Tichaona
authors.initials: T
authors.lastname: Vhembo
authors.forename: Wilfred
authors.initials: W
authors.lastname: Opilo
authors.forename: Rachel
authors.initials: R
authors.lastname: Namuddu
authors.forename: Richard
authors.initials: R
authors.lastname: Katuramu
authors.forename: Jessica
authors.initials: J
authors.lastname: Tezikyabbiri
authors.forename: Bethany
authors.initials: B
authors.lastname: Naidoo-James
authors.forename: Diana
authors.initials: D
authors.lastname: Gibb
mesh_terms: D000349:Africa; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D013607:Tablets / Q000008:administration & dosage* / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D013607:Tablets