Infants and young children are dependent on others for administration of medication; thus, assessment of the capacity for adherence to a complex multidrug regimen requires evaluation of the caregivers and their environments and the ability and willingness of the child to take the drug. Some caregivers may place too much responsibility on older children and adolescents for managing medications.
Educating families about adherence should begin before antiretroviral medications are initiated, and should include a discussion of the goals of therapy, the reasons for making adherence a priority, and the specific plans for supporting and maintaining the child’s medication adherence. Strategies could include information and adherence tools, such as: written and visual materials,a daily schedule illustrating times and doses of medications, and demonstration on using syringes, medication cups and pill boxes (NPHRC, 1999).
Use behavior modification techniques, especially the application of positive reinforcements and the use of small incentives for taking medications, can be effective tools to promote adherence (AIDS Inst. NY State Dept. of Health).
Family-provider meetings structured to discuss such problems and identify potential solutions can be helpful.
For non-adherent infants and young children, consider a gastrostomy tube. GT placement has been shown to enhance HIV medication adherence in a select group of children (Shingadia et. al., 2000). Benefits included reduced medication administration time and improved behavior around taking medications. Home nursing interventions may be beneficial where adequate resources are available (Reynolds et.al., 2001).
Directly observed dosing of ARVs has been implemented in adults with promising results (Mitty et. al., 2002), and such an approach may also be considered for children.