Sub-theme: type of formulation
HIV status.“It
SPILLAGE, BOIL
Most mothers and HCP noted challenges with the type of AZT/3TC formulation. Interviewees unanimously expressed difficulties in measuring and preparing the oral suspension. The dosage was not always well explained by the HCP or well understood by the mothers, especially if illiterate.“Looking at systems used in triple therapy, it’s too much to some clients, they lack that understanding to make those mixtures so, you find that adherence … is affected negatively.” (Nurse; FGD)The drug preparation process was long. It required boiling and cooling water, when clean water was not available, and the drug to dissolve. Contamination from flies and dust was a risk during preparation, requiring the entire process to be repeated. This was a challenge for those with many other duties to be performed, and also for those who had not disclosed their HIV status.“It used to take a lot of time for me to prepare the drug. I needed to boil water, I would wait for it to cool down, and wait for the drug to melt. I used to have a challenge, especially when I was busy with other things.” (Mother, FGD)One mother pointed out that the tablet would not dissolve completely, leaving small particles, which make difficult for the infant to swallow.When asked to compare, all mothers preferred the ready-to-use formulation of lamivudine. The acceptability and fidelity were notably high when there had been no disclosure to relatives. Furthermore, the oral solution is not accessible to children because they cannot open the bottle, unlike the tablets delivered as part of the triple drug prophylaxis. However, participants noted that the formulation of lamivudine could lead to spillage.