28.2  Providing care for HIV-exposed infants and HIV-infected children

Routine childhood services, e.g. immunization, nutrition, OPD (out-patient department) and in-patient (hospital ward) services, are entry points for HIV-exposed and infected children. Health workers should use these services as opportunities to provide access to early diagnosis of HIV for families with children at risk.

As we discussed above, HIV-exposed infants/children should be enrolled into HIV care services and receive a regular follow-up at a health centre or hospital. They should also be given cotrimoxazole prophylaxis to prevent severe infections such as pneumocystis pneumonia (a fungal infection of the lungs), which can cause death in HIV-infected children. Cotrimoxazole prophylaxis is given to HIV-exposed children starting from four to six weeks of age, until a diagnosis of HIV infection is definitely excluded. Those who present late to a health facility should also be given cotrimoxazole prophylaxis.

Cotrimoxazole prophylaxis is also protective against opportunistic bacterial infection, as you learnt in Study Session 21.

Remember that a rapid HIV test is not a reliable test to diagnose HIV infection in children under the age of 18 months. This is because there are maternally acquired antibodies in the blood of the child, and these antibodies can give a false positive HIV test result. Therefore, the best test for diagnosing HIV infection in children less than 18 months of age is a DNA PCR test (see Figure 28.2). This test detects the presence of viral components in blood. However, you are not required to know the details of this test.

Blood samples being collected from a baby.
Figure 28.2  Blood samples are collected from a baby for a DNA PCR test. The samples are collected as a series of ‘dry blood spots’ which will then be tested for the presence of the virus.(Photo: courtesy of UNICEF UK, Lesotho 2007/Gideon Mendel)

The Federal Ministry of Health of Ethiopia has already started a DNA PCR service at several regional laboratories, where blood samples can be sent for analysis to aid early infant diagnosis. DNA PCR can be done as early as six weeks of age. Therefore, you, as a health worker, should encourage the family of an HIV-exposed infant/child to take the infant/child to a nearby health centre for early diagnosis.

DNA PCR does not rely on the detection of antibodies – remember, these could come from either the mother or baby. Instead, this test looks for DNA molecules that can only come from the virus. If the test is positive, it means the virus is in the baby’s blood.

When you encounter such children, either when visiting a household or at the health post, you should inform the family or caregiver about the importance of follow-up care and cotrimoxazole prophylaxis for the HIV-exposed child. The caregiver might not easily recognise the importance of cotrimoxazole prophylaxis and follow-up care, particularly if the child appears to be healthy. Your role is to coordinate the care of the HIV-exposed child with that of the mother.

28.1.3  Differences in the management of children and adults with HIV

28.3  Nutritional and psychosocial support for children with HIV