摘要：Antiretroviral medications are becoming available for HIV-infected children in resource-limited settings. Maryknoll, an international Catholic charity, provided directly observed antiretroviral therapy to HIV-infected children in Phnom Penh, Cambodia. Child care workers administered generic antiretroviral drugs twice daily to children, ensuring adherence. Treatment began with 117 late-stage HIV-infected children; 22 died of AIDS during the first 6 months. The rest were treated for at least 6 months and showed CD4 count increases comparable to those achieved in US and European children. Staffing cost for this program was approximately US $5 per child per month, or 15% more than the price of the medications. Drug toxicities were uncommon and easily managed. Directly observed antiretroviral therapy appears to be a promising, low-cost strategy for ensuring adherent treatment for HIV-infected children in a resource-limited setting. Fewer than 10% of the 660000 children worldwide who are HIV infected and in need of antiretroviral treatment receive such treatment. 1 Cambodia continues to have one of the highest rates of HIV infection in Asia, with a national prevalence of 1.9%. 2 It is estimated that between 3800 and 12000 Cambodian children younger than 16 years were living with HIV as of 2003. 3 Recently, in the wake of dramatic price reductions, highly active antiretroviral therapy (HAART) has become available to a limited number of Cambodian children who are HIV infected, and Cambodian pediatricians are receiving training in the use of HAART. As of 2004, approximately 4200 adults and 314 children were receiving antiretroviral therapy in Cambodia. 2 The Ministry of Health of Cambodia declared a national target of having 1500 children on antiretroviral therapy by 2005. 2 Although community-based treatment models for children with HIV infection will be indispensable for worldwide antiretroviral therapy scale-up, the feasibility of such programs remains largely untested. Adequate adherence to antiretroviral medications is crucial for successful treatment. 4 – 6 Ensuring medication adherence is a particular problem for children who are HIV infected, because they must be given often-unpalatable liquid medications by diverse caregivers. One approach to optimizing medication adherence in children is directly observed treatment. 7
