Management, Care for infants who were born from infected mothers HAIVN Harvard Medical School AIDS Initiatives in Vietnam
Learning Objectives By the end of this session, participants should be able to: • Describe the process of management and care for exposed/infectedchildren • Define OI prophylaxis, immunization and neededlab tests for exposed and infectedchildren
Diagnosis of HIV infection • 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
Importance of management and care for children born fromHIV-infected mothers Management of childrenat OPC can help: • Reduce the mortality • HIV-infectedchildren 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. Note: differentiate between infected and exposed infants
Receiving children • Making medical outpatient chart for HIV exposed infants • Writing the child's name in the logbook for monitoring HIV-exposed infants
Clinical and laboratoryassessment (1) 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 laboratoryassessment(2) Lab test: Indicate as soon as possible appropriate test to confirm HIV statusaccordingly to theirage group. • PCR: 4-6 weeks • ELISA: ≥ 18 months
Counseling and support • Determine who are the main and supportive care givers for the infants • Family and care giversshouldbecounseled on: • Doing HIV confirmative testing for infants. • Immunization and OI prophylaxis for infants • Risk of HIV infection throughbreastfeeding • Psychological and social support • Introduce HIV care and treatment service • Supportive solutions for orphaned and abandoned infants
Management • 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
Follow-up plan and otherneccessary supports • Confirmative diagnosis by testing as soon as possible • Schedule follow-up visit • For infants missingvisit, find out the reasons and establishsupportive solutions. • Schedule visitswheneverabnormallitiesoccur. • Dispense drugs as prescribed. • Coordinate the supports from family and community with available services.
Small Group Discussion Things should be done at the OPC in order to manage well HIV-infected children
Receiving children • 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)
Clinical and laboratoryassessment (1) 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 (2) 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
Counseling and support Similar to exposed children, and add more issues on: • The progress of HIV infection, importance of long-term care and treatment • The 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
Management (1) • 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 (2) • 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.)
Follow-up plan and otherneccessary supports • Making specific schedule of follow-up visits for every infant: 1-2 months/time • For infants missingvisit, find out the reasons and establishsupportive solutions. • Schedule visitswheneverabnormallitiesoccur. • Dispense drugs as prescribed. • Coordinate the supports from family and community with available services.
Vaccinations • 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…
Một số lưu ý khi tiêm chủng • 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.
Key Points • 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
Thank you! Questions?