Acceptability of a new 4-in-1 Abacavir/Lamivudine/Lopinavir/Ritonavir paediatric fixed-dose combination: the caregiver–child dyads’ perspective

Background:

Worldwide, 1.7 million children younger than 15 years were living with HIV in 2021. Only 52% of them had access to antiretrovirals (ARVs). Lack of age-appropriate ARV formulations (i.e. easy to swallow for young infants, acceptable taste) remains the main obstacle to the access to ARVs. Therefore, a strawberry-flavoured Abacavir/Lamivudine/Lopinavir/Ritonavir (30/15/40/10 mg) fixed-dose combination of granules in a capsule (4-in-1) for children living with HIV weighing 3–25 kg was developed.

Objective:

We assessed caregivers’ perceived acceptability of the 4-in-1 compared with previous paediatric ARV formulations and factors influencing acceptability.

Methods:

This exploratory qualitative case study embedded in a phase I/II, open-label, randomized cross-over pharmacokinetic, safety and acceptability study (LOLIPOP) was conducted in three sites in Uganda (May 2019–October 2020). Thirty-six children weighing between 3 and 19.9 kg participated in the main study. We purposively sampled caregiver–child dyads according to weight bands, and conducted 20 semi-structured interviews with caregivers and 5 with healthcare providers. We triangulated these results with a quantitative acceptability questionnaire. We analysed interviews inductively using NVivo12 adopting a thematic analysis approach and acceptability questionnaires descriptively to assess concordance between them.

Results:

All caregivers found the 4-in-1 formulation highly acceptable and easier to use than previous formulations (i.e. pellets/tables/syrup). Appealing taste, ease of administration, easy storage and children’s acceptance contributed to acceptability despite structural challenges of food shortage and HIV stigma. Visible improvements in children’s health and comprehensive and tailored healthcare provider support to overcome initial difficulties such as vomiting increased caregivers’ acceptance. Concordant results from questionnaire- and interview-data confirmed high acceptability.

Conclusion:

Caregivers of children in all weight bands in this sample found the 4-in-1 granules highly acceptable compared with the pellets/tablets combination. Healthcare providers’ support to caregivers allowed for individual tailoring of drug administration despite challenges such as food shortage. This enabled short-term adherence. These findings informed further practical recommendations.

Registration:

Clinical trial number: NCT03836833

Anaerobic digestion as a core technology in sustainable management of organic matter

In the past decades, anaerobic digestion (AD) has steadily gained importance. However, the technology is not regarded as a top priority in science policy and in industrial development at present. In order for AD to further develop, it is crucial that AD profits from the current fuel issues emerging in the international arena. AD can provide low-cost treatment of sewage and solid domestic wastes, which represents a vast application potential that should be promoted in the developing world. Furthermore, the developments in the last decades in the domain of anaerobic microbiology and technology have generated some interesting niches for the application of AD, such as anaerobic nitrogen removal and the treatment of chlorinated organics. Recently, AD has also generated some serendipities, such as the use of AD in processes for sulphur and calcium removal and the coupling of AD with microbial fuel cells. The international developments in terms of bio-refineries and CO2-emission abatement are of crucial importance with respect to the impetus that AD will receive in the coming decade. There should be little doubt that by placing the focus of AD on the production of green energy and clean nutrients, the future of AD will be assured.