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Module II: Diagnosing Paediatric HIV

Module II: Diagnosing Paediatric HIV. Key Questions: How and where do we identify HIV exposed and infected infants and children? What HIV tests should be done on which children and when? What are common symptoms of HIV exposed and infected children?

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Module II: Diagnosing Paediatric HIV

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  1. Module II: Diagnosing Paediatric HIV Key Questions: • How and where do we identify HIV exposed and infected infants and children? • What HIV tests should be done on which children and when? • What are common symptoms of HIV exposed and infected children? • What tool can I use to correctly diagnose and test children?

  2. Infants are most severely affected by HIV infection. Infants respond well to treatment if identified early enough. Without diagnosis and treatment, infants die Mortality Rates for untreated children with HIV MOH-Paediatric HIV/AIDS training for Health professional

  3. Put into real numbers… If 10 positive children are born and none get care… Birth 1 year 2 years 10 years MOH-Paediatric HIV/AIDS training for Health professional

  4. But early diagnosis and treatment decreases AIDS-related pediatric mortality by 75% by allowing us to diagnose children before they get sick. MOH-Paediatric HIV/AIDS training for Health professional

  5. Where do we identify HIV infected and exposed children from? MOH-Paediatric HIV/AIDS training for Health professional

  6. Exposed infants can & should be captured at many different points within a health facility Maternity (at birth) PNC Paediatric OPD Nutrition Unit ANC/PMTCT services Paediatric HIV-Care Lower level health facilities Adult HIV Services (HIV Care, VCT) Paed wards Community: OVC Support Services, Support Groups & PLHA Associations CBOs/NGOs/FBOs, Women groups

  7. Summary of the process for proactively identifying HIV-exposed infants infants

  8. Activity: Diagnosis and Testing for different age groups Groups 1 & 2: Infants to <18 months Groups 3 & 4: > 18 months Task: Each group will answer the following questions for your assigned age: • Who should be tested? • When should they be tested? • Which tests should be done? MOH-Paediatric HIV/AIDS training for Health professional

  9. Who needs to test? TRR All children with an HIV+ MOM MOH-Paediatric HIV/AIDS training for Health professional

  10. Who needs to test? All children with UNKNOWN status MOH-Paediatric HIV/AIDS training for Health professional

  11. Who needs to test? Any child, especially those who are sick with signs of possible HIV (even if previously tested negative) SICK 1. HIV doubles the energy needs of our bodies, causing weight loss. 2. A weakened immune system results in infections. MOH-Paediatric HIV/AIDS training for Health professional

  12. Common signs and symptoms of HIV in exposed babies Dental Caries Molluscum Contagiosum Generalized lymph node enlargement (swelling) Photos from MOH, Uganda EID training program (2010) 3 yrs old MOH-Paediatric HIV/AIDS training for Health professional Ear infections Severe Wasting Stunted Growth

  13. Common signs and symptoms of HIV in exposed babies Skin lesions (common in Kaposi’s Sarcoma) Skin Rash Oral Thrush Photos from MOH, Uganda EID training program (2010) Fungal Infections MOH-Paediatric HIV/AIDS training for Health professional Herpes Zoster

  14. What’s in a drop of blood in someone with HIV? Antibodies (body’s reaction to the virus) In a child < 18m both mom and baby antibodies can be present Mom’s Antibodies Baby’s Antibodies HIV virus MOH-Paediatric HIV/AIDS training for Health professional

  15. Which test should you use?Choose based on child’s age The definitive diagnosis of HIV infection in children at any age requires diagnostic testing that confirms the presence of HIV. MOH-Paediatric HIV/AIDS training for Health professional

  16. Activity:Using the HIVTesting Algorithm to take appropriate actions Use the Testing Algorithm to answer the following questions: 1. Why and when would you perform a rapid test on an infant? • You have a confirmed HIV+ mother who is still breastfeeding, and the exposed infant’s first PCR was negative, what should you do next and when? • Is one positive PCR test enough to start a child on ART?

  17. Diagnosis & Testing Practice Case #1 A 3.5 month old child comes to YCC for immunization. • How do you go about determining the exposure status of the child? • If the child is HIV exposed what test do you do? • If the test is positive what would you do? d) If the test is negative what would you do? MOH-Paediatric HIV/AIDS training for Health professional

  18. Diagnosis & Testing Practice Case #2 You have a 2 year old child who presents in OPD with oral thrush • What test would you use to diagnose HIV in this child? b) If it is negative what would you do? c) If it is positive what would you do? MOH-Paediatric HIV/AIDS training for Health professional

  19. You should never let a mother leave the health center without trying to determine her infant’s HIV exposure status MOH-Paediatric HIV/AIDS training for Health professional

  20. We can make a difference! 1. PREVENT EARLY PMTCT Pro-active HTC 2. TEST EARLY 3. TREAT EARLY ARVs MOH-Paediatric HIV/AIDS training for Health professional

  21. For those HIV infections that we cannot prevent, we CAN identify them early and keep them healthy. MOH-Paediatric HIV/AIDS training for Health professional

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