HIV Testing Criteria

for Children Affected by HIV and AIDS

Prepared initially for the Punjab Province

by the Punjab AIDS Control Programme
and Pak Plus Society

The National AIDS Control Programme

The Punjab AIDS Control Programme

Ministry of Health, Pakistan

Department of Health, Punjab

HIV Testing Criteria for Children

Affected by HIV and AIDS
This criteria for Human Immunodeficiency Virus (HIV) testing is meant to guide
NGOs, medical practitioners and others working with people living with HIV and
AIDS (PLHIV). These criteria will help in identifying when it is appropriate and
relevant to test children of PLHIV for HIV.
Testing for HIV has no clinical contraindications or negative physical consequences,
however the process of testing can be very emotionally taxing. These criteria help to
avoid unnecessary testing.
Early HIV diagnosis for infants and children is critical to bring them into the
treatment care and support stream in order to ensure increased quality of life/wellbeing, and to prolong their lives as long as possible.

Criteria Points for Testing

Less than 18 months of age
All infants born to HIV positive mothers should be tested if possible from 6 weeks after birth with RNA or DNA PCR
testing methodology (viral load).
Antibody tests can be used from 12 months (if no PCR available) for screening out HIV negative children but test
results are not accurate enough (at least 99% specificity) to screen for HIV positivity. By the age of 12 months
most uninfected infants will have lost maternal antibodies and a positive result on an antibody test (rapid or ELISA)
usually indicates HIV infection (96% specificity), however, positive antibody test results under 18 months of age
may be false positives and should be repeated at 18 months.

18 months of age up to 12 years

Children should be tested with antibody tests through Voluntary Counselling and Testing (VCT) process, providing
confidential pre and post test counselling. The adult testing algorithm should be followed and antibody tests used
(rapid, ELISA or Western Blot).
If a child is more than 18 months of age and still being breastfed, cease breastfeeding abruptly before testing with
antibody tests. Antibody tests should be given or repeated after 6 weeks after cessation of breastfeeding.
All children up to 12 years of age should be tested provided their parents became HIV positive before the child
was born, during breastfeeding, or if the parents themselves do not know when they were infected.

Counselling children under 12 years of age

Pre and post test counselling should be done with the parents if the child is still very young. If the child is old/
mature enough to comprehend the the issues related to a life-long illness, after counselling the parents the child

should be counselled in the presence of the parents. Maturity of the child should be determined with the guidance
of the counsellor. In some cases the parents may want to disclose to the child themselves without the counsellor
present. The counselor can guide the parents on the most appropriate way to disclose. If the counsellor feels
strongly the parents are unable to appropriately disclose, they should remain with the child during disclosure.

Additional Issues to Consider

If the mother knows her HIV status is negative, there is no need to test the child - children cannot get HIV
from an HIV negative mother.
If the HIV infected father does not want the mother to be tested or if the mother herself does not want to be
tested despite counselling, but they agree to test the child, the child should be tested. If the child is found to
be positive, counselling with the mother should be reinforced to encourage her to get tested, and to
determine an appropriate feeding option for the child if still an infant.
If the child is over 12 years of age and is suspected to be HIV positive (clinically indicated, intravenous drug
injector, haemophiliac, thalassemia, rape/sexual abuse, etc.), then they should be referred to VCT for
confidential counselling and testing.
Children with congenital immune deficiencies are recommended to have an HIV test.
Breastfeeding: Infant feeding options should be discussed with a doctor from the Prevention of Parent to
Child Transmission (PPTCT) Programme or a Paediatric Infectious Disease Specialist.

AIDS Control Programmes

National
National AIDS Control Programme
National Institute of Health, Chak Shahzad, Islamabad
Phone: 051-7116036

Provincial
Punjab AIDS Control Programme
7th Floor, LDA Plaza, Egerton Road, Lahore, Punjab
Phone: 042-9200982, Fax: 042-9203394

Voluntary counselling and testing (VCT)

services are available at all Treatment
Care and Support Centres.
VCT services are also available with
some established NGOs ask your
relevant Provincial AIDS Control
Programme where VCT services can be
accessed in your province.

Sindh AIDS Control Programme

Import & Inspection Medical Store Depot (M.S Depot), Rafique Shaheed Rd\J.P.M.C, Karachi - Sindh
Phone: 021-9203413, Fax: 021-9201374
Balochistan AIDS Control Programme,
Western Bypass, Near Fatima Jinnah General & Chest Hospital, (TB Sanatorium), Quetta - Baluchistan
Phone: 081-2854182, Fax : 081-2854182
Northwest Frontier AIDS Control Programme
House # 220, E-6, Phase VII, Hayatabad, Peshawar
Phone: 091-5860645

PCR Test
Islamabad/Rawalpindi :




Lahore:


Karachi:

- Pakistan Institute of Medical Sciences (PIMS)

- Armed Forces Institute of Pathology (AFIP)
- Shaukhat Khanum Memorial Hospital (fee if not booked through PACP)
- Sindh Institute of Urology and Transplants (SIUT) (fee if not booked through
PACP)

Rapid/ELISA antibody tests: Rapid tests are available at the treatment, care and support sites. ELISA is
available in every tertiary care hospital but needs special HIV testing kits. Excel and City labs countrywide have
facilities for ELISA HIV testing, as well as all treatment, care and support sites.

Treatment Care and Support Sites

Federal:
- HIV Treatment Centre, Medical OPD, Room No. 6, PIMS, Islamabad, Ph #
051-7116036
Punjab:
- Services Hospital Lahore, Ph # 042-9203402-24
- Mayo Hospital Lahore, Medical OPD 2, Ph # 042-7641179, 7659001
- Shaukat Khanum Hospital Lahore, Ph # 042-5945100-9
- HIV Treatment Centre, DHQ Hospital, Sargodha
Sindh:
- Sindh AIDS Control Programme, Karachi
- Indus Hospital, Karachi
- Chandka Medical College Hospital, Medical unit I, Larkana
- Aga Khan Hospital, Karachi (paediatric HIV only)
Balochistan:
- Bolan Medical Complex, Umer Kitab Ghar, Golimar Chowk, Brewery near B.M.C
Quetta
Northwest Frontier:
- Hayatabad Medical Complex, Peshawar, Ph # 091-9217140-46

Prevention of Parent to Child Transmission (PPTCT) Sites

Islamabad/Rawalpindi :

- Pakistan Institute of Medical Sciences (PIMS), Antenatal

Care, Out-Patient Department (ANC OPD)

Lahore:

- Services Hospital, ANC OPD

- Lady Willington, ANC OPD

Karachi:

- Qatar Hospital, ANC OPD

Quetta:

- Sandaman Provincial Hospital, ANC OPD

Peshawar:

- Hayatabad Medical Complex, ANC OPD