Special treatment support for children and adolescents

Clinical description

• Good adherence is particularly challenging for children and adolescents
• Dependence on caregivers, often in difficult home environment
• Need to adjust ARV dose by body weight
• Developmental and psychosocial changes
• Guardians may falsely assume that older children are independent and no longer need

treatment support:

o Explain to guardian that they are part of their child’s “treatment team”. Their role will change but they will be needed through adolescence and into early adulthood.

• Ask at every visit:

o Who is responsible for supervising the taking of ARVs? o Who stands in for the guardian if s/he is away? Identify at least 2 guardians o How do you give the tablets?

• Discuss possibility of selecting a trusted teacher or fellow student as treatment supporter for

children attending boarding school. Feasibility depends on each school but may be considered.

o Offer to transfer the child to the most convenient ART site closest to school or dispense ARVs for 6 months to allow refill during school holidays.

• Children (just like any other patients) who are adherent and stable on ART can be given 3 months

of drug supply or more if necessary. However, pay attention to weight bands and avoid MMS when dose adjustment is likely at next visit.