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Management, Care for infants who were born from infected mothers

HAIVNHarvard Medical School AIDS

Initiatives in Vietnam

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By the end of this session, participants should be able to:Describe the process of management and care for exposed/infected childrenDefine OI prophylaxis, immunization and needed lab tests for exposed and infected children

Learning Objectives

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Overview

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Most children born from HIV-infected mothers are carrying maternal antibodies• Maternal antibodies will be gradually eliminated

in the first 18 months• Children are confirmed HIV infection if still having

HIV antibodies after first 18 months Diagnosis of HIV infection in infants

• >18 months: ELISA• <18 months: PCR

Diagnosis of HIV infection

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Management of children at OPC can help:Reduce the mortality

• HIV-infected children have the mortality up to 50% in the first 18 months of their life

These children should be developed and grew as other normal children.

Importance of management and care for children born fromHIV-infected mothers

Note: differentiate between infected and exposed infants

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Management of exposed children

Management of exposed children

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Making medical outpatient chart for HIV exposed infants

Writing the child's name in the logbook for monitoring HIV-exposed infants

Receiving children

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Clinical assessment at the first time when register and every follow-up visit:

General condition, clinical symptoms Physical, mental, and cognitive

development Immunization Current medications, side effects (if any) OI diagnosis and treament (if any)

Clinical and laboratory assessment (1)

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Lab test: Indicate as soon as possible appropriate test to confirm HIV status accordingly to their age group.

PCR: 4-6 weeks

ELISA: ≥ 18 months

Clinical and laboratory assessment (2)

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Determine who are the main and supportive care givers for the infants

Family and care givers should be counseled on: • Doing HIV confirmative testing for infants. • Immunization and OI prophylaxis for infants• Risk of HIV infection through breast feeding • Psychological and social support

Introduce HIV care and treatment service Supportive solutions for orphaned and

abandoned infants

Counseling and support

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Provide OI prophylaxis with Cotrimoxazole

Provide treatment for OIs, symptoms, and other conditions (if any)

Admit to hospital with severe cases Seek for consultation from or refer

patients to relevant facilities if beyond treatment capacity

Management

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Confirmative diagnosis by testing as soon as possible

Schedule follow-up visit • For infants missing visit, find out the

reasons and establish supportive solutions. Schedule visits whenever abnormallities

occur. Dispense drugs as prescribed. Coordinate the supports from family

and community with available services.

Follow-up plan and other neccessary supports

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Management of infected children

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Small Group Discussion

Things should be done at the OPC in order to manage well HIV-infected children

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Management of infected children

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Making medical outpatient chart for HIV infected infants

Writing the child's name in the logbook for monitoring HIV-infected infants

Provide out-patient card for infants (if any)

Receiving children

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Clinical assessment at the first time when register and every follow-up visit:

General condition, symptoms, clinical and immunological stages

Physical, mental, and cognitive development Immunization Current medications, side effects (if any) OI diagnosis and treament, screening of TB

and other conditions.

Clinical and laboratory assessment (1)

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Lab tests: Complete blood count, Total

lymphocyte count, ALT: • At the first visit• Every 3-6 months

CD4:• Every 3-6 months or • Infants with severe progress Other necessary tests

Clinical and laboratory assessment (2)

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Similar to exposed children, and add more issues on:The progress of HIV infection, importance of long-term care and treatmentThe need of:

• Clinical monitoring• Doing lab tests to assess the progress of HIV

infection Counseling should be focused on:

• Disclosure of HIV status of infants to family’s members

• Preventive measures of HIV transmission• Safe behaviors practice

Counseling and support

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Provide OI prophylaxis with Cotrimoxazole Provide treatment for OIs, symptoms, and other

conditions (if any) Assess criteria of ARV treatment:

• Not eligible : making long-term plan to follow • Eligible: preparing readiness for ARV treatment

Already on ARV: • Perform the process of follow-up visit• Re-assess, consult to choose proper regimen if

infants referred from other places.

Management (1)

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Admit to hospital with cases:• Complicated OIs• Severe side effects

Seek for consultation from or refer patients to higher level if beyond treatment capacity

Coordination with specialized facilities (TB, dermatology & venerology, etc.)

Management (2)

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Making specific schedule of follow-up visits for every infant: 1-2 months/time • For infants missing visit, find out the

reasons and establish supportive solutions. • Schedule visits whenever abnormallities

occur. Dispense drugs as prescribed. Coordinate the supports from family

and community with available services.

Follow-up plan and other neccessary supports

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Immunization

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Brainstorming

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Widely used across the country : • BCG • Hepatitis B• Diphtheria - Pertusis - Tetanus (3-vaccine combination)• Poliomyelitis (orally) • Measles• Encephalitis due to H. influenzea type b (5-vaccine

combination) • Japanese encephalitis

Optional vaccine:• Encephalitis due to H. influenza type b (single or

combined vaccine) • Varicella, mumps, rubella…

Vaccinations

Vaccines under the National Expanded Program on Immunization

Vaccine Exposed infants

Infected children, clinical

stages 1,2, 3

Infected children, clinical stage 4

BCG as scheduled Do not give Do not give

Diphtheria- Pertussis- tetanus

as scheduled as scheduled as scheduled

Poliomyelitis as scheduled as scheduled Only use injectable vaccine

Hepatis B as scheduled as scheduled as scheduledMeasles as scheduled as scheduled Do not give

5-vaccine combination

as scheduled as scheduled as scheduled

Japanese encephalitis

as scheduled as scheduled as scheduled

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Optional Vaccine

Vaccine Exposed infants

Infected children, clinical

stages 1,2, 3

Infected children, clinical stage 4

Hib as scheduled as scheduled as scheduled

Varicella as scheduled as scheduled Do not giveMumps as scheduled as scheduled Do not give

Rubella as scheduled as scheduled Do not give

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All HIV-exposed children should receive BCG. Postpone vaccination until HIV infection is excluded in following situations: • High risk of HIV infection: mother and infant

not receiving PMTCT• Signs or symptoms suggestive of HIV infection• Having symptoms or conditions of clinical

stage IV • Low birth weight < 2500g,or was born pre-term

After vaccination, it could have swollen lymphonode, enlarged liver and spleen, and cachexia. Consultation with TB specialists.

Một số lưu ý khi tiêm chủng

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HIV infected children have mortality rates up to 50% in the first 18 months of life

For HIV exposed/infected infants/children need to comply with the process of care management: • Receive• Clinical and laboratory assessment • Management• Supportive counseling and monitoring

Need to counsel for care givers on the importance of immunization and monitoring closely its schedule

Key Points

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Thank you!Questions?

- QUY TRÌNH QUẢN LÝ TRẺ EM NHIỄM HIV/AIDS TẠI CƠ SỞ Y TẾ

PHẦN III: QUY TRÌNH ĐIỀU TRỊ ARV

Khẳng định HIV dương tính

Chăm sóc y tế - Tư vấn và hỗ trợ về nuôi dưỡng trẻ - Hỗ trợ tâm lý cho gia đình - Giải thích về chăm sóc và điều trị lâu dài cho trẻ - Theo dõi và đánh giá giai đoạn lâm sàng, xét nghiệm cần thiết - Điều trị dự phòng bằng Cotrimoxazole cho trẻ từ 4 – 6 tuần tuổi, theo

Hướng dẫn quốc gia - Xử trí và điều trị các NTCH, bệnh thông thường, sàng lọc lao , chăm sóc

giảm nhẹ - Đánh giá sự phát triển tinh thần, thể chất của trẻ - Tiêm chủng theo hướng dẫn quốc gia - Phối hợp các chuyên khoa, hoặc chuyển tuyến

Tiếp nhận trẻ Trẻ sinh ra từ mẹ nhiễm HIV chưa khẳng định nhiễm HIV Trẻ có những triệu chứng nghi ngờ nhiễm HIV chưa khẳng

định nhiễm HIV Trẻ nhiễm HIV Lập bệnh án ngoại trú

Khẳng định HIV âm tính

Chuẩn bị sẵn sàng tuân thủ điều trị cho trẻ người chăm sóc trẻ (Sơ đồ 5)

Tư vấn hỗ trợ - Chăm sóc và hỗ trợ tâm

lý, xã hội - Tư vấn và giới thiệu đến

các chương trình hỗ trợ tâm lý, xã hội

- Chuyển gửi cơ sở chăm sóc đặc biệt đối với trẻ mồ côi và trẻ bị bỏ rơi

Kế hoạch theo dõi - Lịch hẹn khám định kỳ - Phát thuốc theo chỉ định - Kết hợp với các hỗ trợ cộng đồng và gia đình - Hoàn chỉnh hồ sơ bệnh án - Trẻ chưa xác định nhiễm HIV cần làm xét nghiệm khẳng định càng sớm càng tốt

Bắt đầu điều trị ARV

Trẻ dưới 18 tháng chưa xác định nhiễm HIV nhưng có kháng thể HIV (+)

Đủ tiêu chuẩn lâm sàng điều trị ARV

Có

Không

Tư vấn và xét nghiệm HIV Theo Hướng dẫn quốc gia

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