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 professionals 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 higher health facility 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.
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 below). This test detects the presence of viral components in blood. However, you are not required to know the details of this test.
DNA PCR can be done as early as six weeks of age. Therefore, you, as a health professional, should encourage the family of an HIV-exposed infant/child to take the infant/child to a nearby higher health facility 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 facility, 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.