Srinivasan, Priyanka1, Tucker, John2, Phok Many2

1
Srinivasan, Priyanka1, Tucker, John2, Phok Many2

1Stanford University, Stanford, CA 2New Hope for
Cambodian Children, Phnom Penh, Cambodia
2
Issues
Background
Challenges

• Largest pediatric home-care program in Asia
• 930 children receiving care at home by a parent,
  grandparent, or other caregiver

• Compliance to complex drug regimens
• Switching to second line medications is
  cost-prohibitive
• Unsophisticated resistance testing

Research Objectives

• Determine common reasons caregivers forgot to
  administer (or improperly administered) ART to
  child that is, identify specific pain points
  of delivering complex ART regimens at home
• Assess orphan status, educational attainment and
  health of caregiver, household income, HIV stigma
  in community

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Barriers to Adherence
4
Policy Directions

• Adherence difficult to ensure at beginning of
  treatment
• Calls for a modified directly observed treatment

• Costs
• At least 5-7 per month per child
• More cost-effective for children who live
  relatively close to hospital
• Additionally, in-hospital counseling and pharmacy
  services should be strengthened