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Care priority and warning signs
Care priority
Offer HIV Testing & Counselling
Red flags
- Child presenting with signs suggestive of HIV infection (recurrent severe infections, failure to thrive, thrush etc.) increases urgency for testing.
Assessment
- Ask: Has the mother or child had an HIV test? (Answer is No, or status unknown).
- Confirm child is less than 18 months old (as management differs slightly for older children where child testing might be offered directly).
Classification
- HIV test not done for mother or infant child less than 18 months old -> HIV INFECTION STATUS UNKNOWN
Key features
- HIV status of mother and child is unknown.
- Child is young enough (<18m) that maternal status is the primary determinant for exposure risk assessment.
- Requires offering HIV testing and counselling (HTC) to the mother.
Management
Non-pharmacological management
- Encourage mother to go for HIV counselling and testing in a health facility.
- Provide general health and feeding advice based on age.
Pharmacological treatment
- Treat any current illness according to IMCI guidelines.
- Withhold Co-trimoxazole until mother/child status is known (unless child is severely malnourished or has confirmed TB where prophylaxis might be indicated regardless - check national guidelines).
Follow-up
- Follow up depends on whether mother accepts testing.
- If mother tests positive, manage child as HIV Exposed.
- If mother tests negative, manage child as HIV Infection Unlikely.
- Follow up for presenting illness as needed.
Counselling points
- Explain the importance of knowing HIV status for the health of both mother and child.
- Offer HIV testing and counselling sensitively.
- Explain the testing process and confidentiality.
- Provide general health messages.
Differential diagnosis
- Child could be HIV Exposed or HIV Unlikely depending on mother's actual status.
Complications
- Delayed diagnosis of HIV infection in mother or child.
- Missed opportunity for PMTCT in future pregnancies.
- Child may unnecessarily lack prophylaxis if exposed, or receive it if not needed.
Prevention
- Routine offering of HIV testing in antenatal care, labour/delivery, postnatal care, and child health services.
References
IMCI Chart Booklet - Page 8