All sick children and their mothers should be tested and assessed for HIV exposure and infection. When you are assessing the HIV status of the mother and the child you should present the question gently and maintain confidentiality. During your assessment, you should include both the mother and the children and check their HIV status.

HIV status of the mother

HIV antibody (serological) tests or rapid tests are used for knowing the maternal HIV status. A mother with positive antibody test result is taken as HIV-infected mother, and the negative test result is considered to be uninfected. If the mother is not tested for HIV, she is considered to be "Unknown Status". If the mother is not tested and is unknown, you should advise her for HIV screening.

HIV status of the child

Different tests are available to diagnose HIV infection in children (serological test, to detect the anti body of HIV and virological tests to detect the virus). Serological or antibody tests, including Rapid tests, detect only antibodies, but they do not detect the virus itself. Antibodies from the mother pass on to the child and in some instances do not disappear until the child is 18 months of age. This means that a positive antibody test in children under the age of 18 months does not confirm that the child is truly HIV infected. On the other hand, virological tests such as DNA PCR test directly detect HIV in the blood. These tests can detect HIV infection in the child as early as 6 weeks old (before 18 months).

Is the child breastfeeding?

Breastfeeding accounts for 30 to 40% of mother to child HIV transmission if it continues up to 2 years of age. This means a child on breastfeeding is on continuous exposure for HIV transmission.

A negative PCR or antibody test in a breastfeeding child at any age should be repeated 6 weeks after breastfeeding stopped to confirm HIV infection status. If you understand the mode of transmission of HIV, you will properly assess it, classifying the HIV infection based on the test results and counsel the mother to give care for her child.

First, during your assessment, ask the parents about her child illness:

ASK:

  • Has the child had any positive HIV test?.
  • Has the mother had a positive HIV test?.

Assess and Classify Infants by Test Result

Signs Classify as: Treatment
Any positive blood test in a child age >18 month OR Positive PCR test in a child <18 months.
 CONFIRMED HIV INFECTION

  • If only the mother or the child is tested, advise the mother on the need for testing both.
  • If mother and child are already on follow-up at the health centre or hospital, advise on the need to continue.
  • If the follow-up is not started, refer to the health centre or hospital.
Antibody test positive in a child <18 months AND/OR mother positive. POSSIBLE HIV INFECTION (HIV EXPOSED)

  • If only the mother or the child is tested, advise the mother on the need for testing both.
  • If the mother and child are already on follow-up at the health centre or hospital, advise on the need to continue
  • If the follow-up is not started, refer to the health centre or hospital.
Mother and child have never been tested for HIV. UNKNOWN HIV STATUS
  • Counsel the mother on voluntary testing.
Mother only tested and HIV negative, OR Mother and child HIV negative. HIV INFECTION UNLIKELY

  • Praise the mother for being tested.
  • Advise the mother to keep herself free of HIV.
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Last modified: Wednesday, 1 March 2017, 2:00 AM