The name of the child in this story has been changed to protect confidentiality.
Sonnu, 11 years old, was living in the Kandivali slums outside of Mumbai with his uncle, his older sister, and his younger brother. The siblings had sadly lost their mother a few years earlier. Sonnu had been diagnosed with HIV and been monitored since he was 10 years old by a nongovernmental health care organization. In 2007, when he was 11, he developed TB, and began taking first-line drugs. Soon after, his doctors confirmed that his strain of TB was resistant to six drugs. They counseled Sonnu and his uncle before starting a DR-TB treatment regimen of six drugs.
However, in later adherence counseling sessions, it appeared that Sonnu’s uncle had become less caring toward Sonnu and his siblings—he treated the children like servants, ordering them to cook for him and clean the house. The uncle was also trying to take the house (which was in Sonnu’s mother’s name) away from them. As a result, Sonnu and his siblings stopped respecting and listening to their uncle, and this affected Sonnu’s treatment adherence. He would take his tablets at home in front of his uncle, and vomit them out in the bathroom. His uncle, indifferently and irresponsibly, did not report this to Sonnu’s doctors, nor did he enforce Sonnu’s attendance to important medical appointments.
Sonnu’s counselors worked intensively with Sonnu and his uncle, both independently and together, to address these behavioral issues. They added a directly observed therapy provider to monitor treatment. Sonnu’s siblings were enrolled in boarding school so that the uncle could pay closer attention to Sonnu. After seven months of DR-TB treatment, and additional counseling, Sonnu began first-line antiretroviral therapy for HIV.
Over time, Sonnu’s adherence to both the DR-TB treatment and antiretroviral therapy improved. At the age of 13, Sonnu completed his course of DR-TB treatment. After rapid improvement in his CD4 count, his HIV care was transferred to a government center, where he continued to receive treatment.