module ii: diagnosing paediatric hiv
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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? - PowerPoint PPT PresentationTRANSCRIPT
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?
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Infants are most severely affected by HIV infection.Infants respond well to treatment if identified early enough.
Without diagnosis and treatment, infants die
At 1 year 30%
At 2 year 50%
At 5 year66 – 75%
At 10 years
85%
Mortality Rates for Mortality Rates for untreated children with untreated children with
HIVHIV
Put into real numbers…
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Birth
1 ye
ar
2 ye
ars
10 ye
ars
If 10 positive children are born and none get care…
But early diagnosis and treatment decreases AIDS-related pediatric
mortality by 75%
by allowing us to diagnose children before they get sick.
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Where do we identify HIV infected and exposed children from?
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ANC/PMTCT services
Paed wards
Paediatric HIV-Care
Adult HIV Services (HIV
Care, VCT)
Paediatric OPD
Lower level health facilities
Community:OVC Support Services, Support Groups & PLHA
AssociationsCBOs/NGOs/FBOs, Women groups
Maternity (at birth)PNC
Nutrition Unit
Exposed infants can & should be captured at many different points within a health facility
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Summary of the process for proactively identifying HIV-exposed infants infants
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Activity: Diagnosis and Testing for different age groupsGroups 1 & 2: Infants to <18 monthsGroups 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?
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Who needs to test?
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All children with an HIV+ MOM
TRR
Who needs to test?
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All children with UNKNOWN status
Who needs to test?
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1. HIV doubles the energy needs of our bodies, causing weight loss.
2. A weakened immune system results in infections.
Any child, especially those who are sick with signs of possible HIV
(even if previously tested negative)
SICK
Molluscum Contagiosum
Generalized lymph node enlargement (swelling)
Ear infections
Dental Caries
Severe Wasting Stunted Growth
3 yrs old
Common signs and symptoms of HIV in exposed babies
Photos from MOH, Uganda EID training
program (2010)04/22/23 MOH-Paediatric HIV/AIDS training for
Health professional 12
Skin lesions (common in Kaposi’s Sarcoma) Oral Thrush
Fungal InfectionsHerpes Zoster
Skin Rash
Common signs and symptoms of HIV in exposed babies
Photos from MOH, Uganda EID training program
(2010)
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What’s in a drop of blood in someone
with HIV?Antibodies (body’s reaction to the virus)
HIV virus
Mom’s Antibodies
Baby’s Antibodies
In a child < 18m both mom and baby antibodies can be present
6 weeks to <18 months 18 months and above
DNA PCR using Dry Blood Spot (DBS)
(Virologic)
Serial Rapid Tests
(Antibody)
Which test should you use?Choose based on child’s age
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The definitive diagnosis of HIV infection in children at any age requires diagnostic testing that confirms the presence of HIV.
Activity: Using the HIV Testing 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?
2. 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?
3. Is one positive PCR test enough to start a child on ART?
Diagnosis & Testing Practice Case #1
A 3.5 month old child comes to YCC for immunization.
a) How do you go about determining the exposure status of the child?
b) If the child is HIV exposed what test do you do?
c) If the test is positive what would you do?
d) If the test is negative what would you do?
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Diagnosis & Testing Practice Case #2
You have a 2 year old child who presents in OPD with oral thrush
a)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?
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You should never let a mother leave the health center without trying to determine
her infant’s HIV exposure status
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1. PREVENT EARLY
2. TEST EARLY
3. TREAT EARLY
We can make a difference!
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PMTCT
Pro-active HTC
ARVs
For those HIV infections that we cannot prevent,
we CAN identify them early and keep them healthy.
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