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How can we simplify antiretroviral therapy in children?

Purpose of reviewThe aim of this article is to present approaches towards simplifying pediatric antiretroviral therapy in order to improve access to care, coverage of HIV-positive children, and support adherence to treatment. Recent findingsBarriers to rapid and effective global scale-up of pediatric antiretroviral therapy include the narrow range of available pediatric antiretrovirals, complicated dosing schedules, and social and economic instability of the family caused by poverty, stigma, and death. Healthcare providers can simplify antiretroviral therapy delivery by promoting the development and use of pediatric fixed dose combinations and scored adult antiretrovirals, using weight-band dosing tables to prescribe antiretrovirals, and identifying less complex regimens. Caretakers would benefit from active counseling to facilitate more open communication with their children about adherence and disclosure. Children can develop long-term coping strategies through learning life skills that build confidence and improve decision-making. Whenever possible, antiretroviral therapy programs should provide access to free antiretrovirals, identify funds to cover transportation costs, and refer families to available community support programs. SummaryInterventions to simplify the administration of antiretroviral therapy need to address not only how antiretrovirals are prescribed and formulated, but the relationships of HIV-positive children with their families and communities as well.