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. Without diagnosis and treatment, infants die
Mortality Rates for untreated children with HIV
At 1 year
30%
At 2 year
50%
At 5 year
66 – 75%
At 10 years
85%
Infants are most severely affected by HIV infection.
Infants respond well to treatment if identified early enough.
This slide is meant to emphasize that fact that HIV progresses faster in children.
The facilitator must emphasize the fact that much as their disease progress is fast, they also respond well to treatment when identified early.
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MOH-Paediatric HIV/AIDS training for Health professional 2

3. MOH-Paediatric HIV/AIDS training for Health professional
Put into real numbers…
If 10 positive children are born and none get care…
This put the percentages in previous slide into reality.
By one year not that 3 out of 10 children will have died and only 7 are remaining.( 1/3)
By 2 years half of the children have died
By 10 years 8 out 10 have died.
Birth
1 year
2 years
10 years
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MOH-Paediatric HIV/AIDS training for Health professional

4. by allowing us to diagnose children before they get sick.
But early diagnosis and treatment decreases AIDS-related pediatric mortality by 75%
CHER study in south Africa showed that Starting infants on ART as soon as possible after diagnosis leads to 75% reduction in mortality compared to those in whom treatment initiation is delayed until immunological decline and clinical symptoms develop.
After this slide, the facilitator should then divide the team into 3 groups for group discussion as guide
by allowing us to diagnose children before they get sick.
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MOH-Paediatric HIV/AIDS training for Health professional

5. Where do we identify HIV infected and exposed children from?
The facilitator should solicit responses from participants before moving to the next slide.
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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)
Infants should be identified at all points within the facility and even in the community.
Infants can as well be identified in adult wards. eg you may find an HIV positive man admitted on the ward and the wife is taking care of him but has young baby . That mother and baby should be tested for HIV. If mother is positive this child even if well, should have a PCR test, start on septrin and should be referred for care and follow up.
Paed wards
Community:
OVC Support Services, Support Groups & PLHA Associations
CBOs/NGOs/FBOs, Women groups
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7. Summary of the process for proactively identifying HIV-exposed infants infants
1. Check child health card of every infant for mother’s HIV Status
If mother is HIV-positive, counsel and refer infant for PCR testing
2. Check mother’s ANC card if no indication from child card
3. If mother’s HIV status unknown, perform a rapid HIV test on her
If mother is HIV-positive, refer her to immediate ART care and her infant for PCR testing
4. If unable to HIV test mother, perform a rapid HIV test on infant
If infant’s rapid test is positive, he/she is HIV-exposed. Counsel & refer for PCR testing
Facilitator should be familier with PMTCT codes. Most time participants know this
These codes are indicated in the ANC and Child health card and can be used to identify which infant is Hiv exposed.
TR- Test and HIV negative
TRR- tested and HIV positive .
TRRDm Tested, Positive and mother received drug
TRRDmb Tested , Positive , both mother and baby received drug.
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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?
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MOH-Paediatric HIV/AIDS training for Health professional

9. Who needs to test? All children with an HIV+ MOM TRR
They should be able to tell which babies are exposed from the process of proactively identifying exposed infants.
Need to emphasize where they should look in the Child health care and ANC for the codes.
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MOH-Paediatric HIV/AIDS training for Health professional

10. Who needs to test? All children with UNKNOWN status
For all children with unknown Status, the mothers HIV status should be determined first then if she is positive , then the child should be tested for HIV.
This means RTC should be active at all entry points in the facility.
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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.
Some infants are still likely to come with infections that are suggestive of HIV.
Some infants have not go through PMTCT at all and they don’t access early testing and treatment and are likely to develop infections.
There should be active identification of these infants in the Paediatric wards and OPD and should be tested.
At this point you need to emphasize the importance of RTC in the paed ward and OPD, Nutrition unit.
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MOH-Paediatric HIV/AIDS training for Health professional

12. Common signs and symptoms of HIV in exposed babies
Dental Caries
Molluscum Contagiosum
Need to emphasize that these are signs of Late HIV infection. If early diagnosis is done and treatment started most infants will not reach this stage of illness. They will have normal growth.
Much as we shall have some children still presenting with these, we need to put emphasis on early diagnosis and treatment so that we have children grow normally.
Generalized lymph node enlargement (swelling)
Photos from MOH, Uganda EID training program (2010)
3 yrs old
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MOH-Paediatric HIV/AIDS training for Health professional
Ear infections
Severe Wasting Stunted Growth 12

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
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MOH-Paediatric HIV/AIDS training for Health professional
Herpes Zoster 13

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
Antibodies are our bodies’ reaction to the virus
In children under 18 months of age, you have both maternal antibodies. This makes use of antibody tests unreliable for diagnosis of HIV in these children.
This slide builds on knowledge for why DNA PCR test is recommended for children under 18 months while rapid tests can be used for infants 18 month and above.
Baby’s Antibodies
HIV virus
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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.
6 weeks to <18 months
18 months and above
DNA PCR using Dry Blood Spot (DBS)
(Virologic)
Serial Rapid Tests
(Antibody)
Because mom’s antibodies can stay in a child’s blood until 18 mos, we have to use a DNA PCR test in children < 18m to look for the virus itself
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MOH-Paediatric HIV/AIDS training for Health professional

17. 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?
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?

18. 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?
The participants should be able to go through the process of proactively identifying exposed infants as stated in the slide 11.
b)The recommended test for this child is DNA PCR.DBS is used to take a sample.
c) If Positive would refer the children to ART clinic, start septrin and ART.
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MOH-Paediatric HIV/AIDS training for Health professional

19. 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?
Use HIV rapid test
If Negative repeat a test after 3 month
If positive start septrin, refer to ART clinic , stage and do CD4 count
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MOH-Paediatric HIV/AIDS training for Health professional

20. MOH-Paediatric HIV/AIDS training for Health professional
You should never let a mother leave the health center without trying to determine her infant’s HIV exposure status
These are key messages to summarise the talk.
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MOH-Paediatric HIV/AIDS training for Health professional

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

22. MOH-Paediatric HIV/AIDS training for Health professional
For those HIV infections that we cannot prevent, we CAN identify them early and keep them healthy.
This is a key message.
As you can note from the pictures, the children smiling and healthy though HIV infected.
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MOH-Paediatric HIV/AIDS training for Health professional