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Care priority and warning signs
Care priority
Encourage Urgent HIV Testing for Mother
Red flags
- Infant showing signs suggestive of HIV infection increases urgency for maternal testing.
Assessment
- Ask: Has the mother had an HIV test? (Answer is No, or status unknown).
- Confirm infant has not had HIV testing.
Classification
- HIV test not done for mother or infant -> HIV INFECTION STATUS UNKNOWN
Key features
- HIV status of mother (and therefore infant exposure) is unknown.
- Requires urgent HIV testing and counselling (HTC) for the mother to guide infant management.
Management
Non-pharmacological management
- Strongly encourage mother to go for HIV counselling and testing immediately.
- Provide general infant care advice.
Pharmacological treatment
- Treat any current illness according to IMCI guidelines.
- Do NOT start Co-trimoxazole or infant ARV prophylaxis until mother's status is known.
Follow-up
- Depends on mother accepting testing.
- If mother tests positive -> Manage infant as HIV Exposed.
- If mother tests negative -> Manage infant as HIV Infection Unlikely.
- Follow up for presenting illness.
Counselling points
- Explain the importance of knowing mother's HIV status for the baby's health.
- Offer/facilitate immediate HIV testing and counselling for the mother.
- Explain confidentiality.
Complications
- Delayed diagnosis of maternal/infant HIV.
- Missed opportunity for PMTCT.
- Delayed infant prophylaxis if exposed.
Prevention
- Routine offering of HTC in all maternal and child health settings.
References
IMCI Chart Booklet - Page 36 (Classification), Page 37 (Management)