Counseling and Testing of infants and

Children

Asunta Adut Akeen

 Key Abbreviations
Dried Blood Spot (DBS)

Deoxyribonucleic AcidPolymerase Chain

Reaction (DNA-PCR)
 Introduction
Although clinical features are used to make
diagnosis of HIV infection, very often they overlap
with features of other diseases

Confirmatory diagnosis thus depends on laboratory

tests, which can be divided into 2 categories:
Antibody tests: cheaper and easy to perform
Virologic tests: expensive and complex
 Diagnosis and Clinical Staging
HIV diagnosis in children requires a high index of suspicion,
knowledge of the nature of HIV disease and good skills for
communication
Diagnosis may be:
Clinical - based on signs and symptoms, or
Clinical supported by laboratory findings.
HIV and AIDS should be suspected in children with
suggestive clinical features or HIV-associated conditions
 Laboratory Diagnosis
There are 2 broad categories of tests:
Antibody detection (reliable in children above 18 months of
age)
HIV Rapid test

ELISA & Western blot

Virologic tests (most useful in children below the age of 18

months)
DNA PCR (plasma viral load)
 HIV Antibody Testing
All infants born to HIV+ mothers will test HIV
antibody positive
Positive HIV antibody test will not distinguish
whether or not the infant is HIV-infected. Only
indicates:

Mother is HIV-infected
Infant is at risk for HIV infection
 Virologic Tests

Virologic tests must be used for children

HIV DNA PCR

A positive Virologic test result indicates HIV

infection

Treatment must be commenced whether infant is

symptomatic or not/or rapidly progressing
 Pre-test Counselling Messages

Mother to Child Transmission (MTCT): HIV may be passed

from the mother to the infant during pregnancy, delivery,
and breastfeeding. Even if your infant does not seem sick,
s(he) still might be HIV-infected.
Prevention of Mother to Child Transmission (PMTCT): The
medicines you and your baby are taking help prevent
infection, but we need to do an HIV test to find out for sure
whether or not your baby is infected.
HIV Infection: Children with HIV infection need care and
treatment. Without treatment, many children living with
HIV will become very sick and die.
 Pre-test Counselling Messages
Early Diagnosis: HIV disease develops much faster in
children than it does in adults. It is very important that
we identify HIV infection as early as possible in children
and start treatment immediately.

Life-saving Treatment: Knowing your childs HIV status

for sure can help you and your family plan for the
childs care and make sure the child gets the care and
treatment he or she needs as early as possible. HIV
care and treatment, including ARVs, can help save your
childs life and help him or her grow and become a
healthy adult.
 Pre-test Counselling Messages
Timing: All babies who are born to mothers living with
HIV should have an HIV test when they are 6 weeks
old, and again when they are 9 months and when they
are 18 months old, or six weeks after you stop
breastfeeding.
Process: For the first test we use a Dried Blood Spot
sample, also called a DBS. To get a DBS sample, we will
prick your childs heel with a small needle and put
some drops of blood on a piece of paper. The paper
will then be sent to a lab, and we will get the results
back in about 23 weeks.
 Pre-test Counselling Messages
Consent: You have the right to say anything you
want to know about this testing. If you say that
you dont want your child tested, we will talk with
you more and still take care of you and your child.
Confidentiality: The result of your childs HIV test
is confidential; it is only shared with those health
care workers who need this information in order
to care for your child. It will not be shared with
other family members without your consent
 Post-test Counselling Messages
for a Negative Virologic (DNA PCR) HIV Test at 6
Weeks of Age
Negative Test Result: The results are negative, which
means the virus is not detected in your childs blood
right now. However, your infant may still be at risk and
will need additional testing to determine a final
diagnosis.
Prevention of Mother to Child Transmission: Even
though your babys test result was negative today, s(he)
is still at risk for becoming infected during
breastfeeding. Be sure to continue taking your ART
regimen every day.
 Post-test Counselling Messages
Repeat Testing: Bring your baby back for repeat
testing if your baby develops any signs or
symptoms of illness. Bring your baby back for
repeat testing at 9 months and again 6 weeks
after you stop breastfeeding completely.
Final Diagnosis: When your baby is 18 months
old or 6 weeks after you stop breastfeeding, we
will do one more test to determine your babys
final HIV status.
 HIV TESTING ALGORITHM FOR
INFANTS AND CHILDREN BELOW 18
MONTHS OF AGE
A Virological test (DNA PCR) is the
recommended test for determining the HIV
status in infants and children below 18
months of age. The sample for testing should
be collected using dried blood spot (DBS)
specimens.
The 1st DNA-PCR test should be done at six
weeks of age or the earliest opportunity
thereafter
 A POSITIVE DNA PCR test result indicates that the
child is HIV-infected.
All infants with a positive DNA/PCR test results
should be initiated on ART, and another blood
sample is collected on the day of ART initiation to
confirm the positive DNA/PCR HIV test result.
A NEGATIVE 1st DNA PCR test result means that
child is not infected, but could become infected if
they are still breastfeeding. Infants testing HIV
negative on DNA/PCR should be re-tested six
weeks upon cessation of breastfeeding
 Infants with negative 2nd DNA/PCR test should
have a final rapid antibody test performed at
18 months.
 Supporting the Mother or Caregiver
of an HIV-Infected Infant
Provide supportive counselling to the mother or
caregiver to help her process a positive HIV test
result and its implication for her infants life
Mothers and caregivers may feel guilty, sad, or
angry. It is important to acknowledge and
validate whatever they are feeling.
If the mother tries to argue or deny the result,
listen to what she says and then explain the
information you have again. Show her the results
if she wants to see them.
 Hiding or avoiding the truth will only delay the process of
adapting. Showing honesty, openness, and acceptance will
help support the healing process.

Convey the message that early diagnosis may have saved

the childs life. Reassure the mother or caregiver that with
early and consistent care the infant can grow and thrive.
Be patient. Immediately after a difficult diagnosis the
mother may not be able to absorb complex information, or
she may not want to hear it. Follow up as needed to be
sure the infant and mother get the care they need.