Projects Galore
This week has been the most busy and productive week we have had in Swaziland by far. Starting on Monday, we started formulating an algorithm to calculate the number of clips a clinic would need to order based on the number of births they have. There are two liquid ARVs that we would have to consider, Nevirapine and Kaletra. Here is some background to those new to this field: Nevirapine is used in the Prevention of Mother To Child Transmission (PMTCT) program that has begun in Swaziland, so all kids with HIV+ mothers should be taking Nevirapine. If the child does contract HIV despite trying to prevent its transmission with Nevirapine, Kaletra is administered. However, while Nevirapine’s dosing is done based on the age of the child, Kaletra is dosed based on the weight of the child. To decide how many of each size of dosing clips would be required by a clinic thus is related to the number of children in each particular dosing weight category. Figuring out the average weight of a child was thought-provoking. After consulting doctors here, we decided that we would approximate the number of children in each weight band based on the average weight of the 10th-25th percentile of children in Africa: remarkably low, isn’t it?
On the front of our liquid ARV adherence project, we looked into what had been done in Lesotho. They had used a tongue-depressor as a dipstick to measure the amount of liquid remaining an a bottle. Unfortunately, our adventures in the Baylor pharmacy revealed to us that tongue-depressors in Swaziland do not fit into the liquid medication bottles. We tried our straw method on Nevirapine medication, and unfortunately, the consistency of Nevirapine prevents it from being held up by suction in a straw. We will probably have to find some other material to use as a dipstick!