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Assessing user preferences for design characteristics of oral dissolvable strips for pediatric HIV medication: a qualitative study
Wexler, Catherine Maloba, May Sliefert, Michala Babu, Shadrack Maosa, Nicodemus Maliski, Edward Nicolay, Zachary Were, Frederick Mbithi, Yvonne Mugendi, George
Wexler, Catherine
Maloba, May
Sliefert, Michala
Babu, Shadrack
Maosa, Nicodemus
Maliski, Edward
Nicolay, Zachary
Were, Frederick
Mbithi, Yvonne
Mugendi, George
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Abstract
Background
Current infant antiretroviral therapy formulations pose barriers to daily adherence due to complex weight-based dosing, conspicuous preparation, and poor palatability. These adherence barriers jeopardize adherence, making patients vulnerable to virologic failure, development of drug resistance, and preventable mortality. Our team has previously established proof-of-principle for multi-drug oral dissolvable strips as alternative pediatric antiretroviral formulations with the potential to overcome these challenges and improve pediatric ART adherence and outcomes. The objective of this study was to assess caregiver and provider preferences for oral dissolvable strips and its packaging to inform its development.
Methods
Guided by concepts of user-centered design, we conducted key informant interviews with 30 HIV care providers and focus group discussions targeting caregivers of children < 10 years of age living with HIV at 3 Kenyan hospitals. Key informant interviews and focus group discussions were audio recorded, translated/transcribed verbatim, and hand coded for a-priori and emergent themes.
Results
A total of 30 providers and 72 caregivers (caring for 83 children, aged 5 months to 18 years) participated in the study. Caregivers and providers expressed a strong desire for an easier way to administer medication, especially among children too young to swallow tablets whole, and expressed enthusiasm around the idea of oral dissolvable strips. Key preferences included a pleasant taste; one strip per dose; small size with rapid dissolution; clear markings and instructions; and no special storage requirements. For packaging, stakeholders preferred individually wrapped strips within a dispenser. The individual packaging should be durable, waterproof, and easy to dispose of in communal spaces. They should also be easy to open, with clear indications where to open. The packaging holding the strips should be durable, re-usable, accommodating of various refill frequencies, and easy to use for children as young as 6.
Discussion
The concept of oral dissolvable strips was highly acceptable to caregivers of children living with HIV and HIV care providers. By engaging stakeholders in an iterative design process starting from the early phases of design and development, we will maximize the likelihood of developing a product that is acceptable to the caregiver and infant, therefore leading to sustainable adherence.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12913-023-10078-6.
Description
Date
2023-10-16
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Springer
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Keywords
HIV, Pediatric antiretroviral therapy, Antiretroviral therapy adherence, Kenya, Qualitative research, User-centered design
Citation
Wexler C, Maloba M, Sliefert M, Babu S, Maosa N, Maliski E, Nicolay Z, Were F, Mbithi Y, Mugendi G, Thomas G, Acharya H, Finocchario-Kessler S. Assessing user preferences for design characteristics of oral dissolvable strips for pediatric HIV medication: a qualitative study. BMC Health Serv Res. 2023 Oct 16;23(1):1103. doi: 10.1186/s12913-023-10078-6. PMID: 37845699; PMCID: PMC10580521