Standard procedures

Paediatric HIV care QECH

Provider initiated testing and counselling for all admissions is the departmental and national policy. PLEASE WRITE HTC FOR EVERY PATIENT AS YOU CLERK IN and at DAILY REVIEW UNLESS THE STATUS IS KNOWN AND DOCUMENTED.
The nurse then directs the parent/guardian to the admissions room, where the testing is available 8AM-4PM, Monday – Friday. Fathers are also welcome to have a HIV test.

Testing in the different age groups for children exposed to HIV

>24 months: rapid test

12-24 month: If the CHILD IS WELL and rapid test is negative and has not breastfed for 3 months then the child is considered negative, but continue CPT and review every 3 months and repeat rapid test at 12 and 24 months or 6 weeks after breast-feeding has stopped to confirm that the child is negative. If the rapid test is positive, continue CPT, send for counselling start ARVs and take confirmatory DNA-PCR as soon as possible. No further follow up tests are needed.

<12 months: DNA PCR. For children <12 months, known to be exposed then a DNA PCR must be done and the mother asked to come back for the results. If the child meets the criteria for presumptive severe HIV then start ARV and take a confirmatory DNA-PCR as soon as possible. Confirming status with rapid test at 24 months is not needed.

Counselling is in the Family clinic Tuesday, Wednesday and Friday mornings at 07.30

Breast-feeding in exposed infants

Mothers are encouraged to exclusively breastfeed for the first 6 months
Complementary feeds should be introduced at 6 months
Aim to stop breastfeeding before the age of 22 months, so that the final HIV test can be done at age 24 months (6 weeks after breastfeeding has stopped).
Stop breastfeeding gradually over a period of 1 month (no rapid cessation).

Care pathway for positive children

Since April 2016 the National HIV Programme has adopted the TEST AND TREAT strategy (everybody who tests HIV positive is eligible to start ART as soon as possible).
When the child is diagnosed as HIV positive send the child directly to the Umodzi Family Clinic to book ART Counselling. Although, staging and CD4 count are not needed anymore to start a child on ART, it is recommended to stage all children in their first visit to clinic.
For Cotrimoxazole Preventive Therapy see CPT