HIV testing for Children

Transcription

1 HIV testing for Children Dr. Sok Panha NCHADS (VCCT and LS unit ) First National Conference on Pediatric AIDS Care in Cambodia 5-66 February 2007

2 Testing for HIV/AIDS Diagnosis and Treatment For HIV diagnosis HIV antibody (Rapid test, ELISA, PA) DNA PCR (for infant diagnosis) For HIV/AIDS care and treatment CD4 count Viral load

3 Testing for HIV/AIDS Diagnosis

4 VCCT VCCT: entry point for both Prevention and Care First VCCT established in 1995 at Institute Pasteur of Cambodia Between VCCTs: 4 VCCTs - stand-alone alone 2 VCCTs integrated in the Public Hospitals From 2002 to Dec 2005, 103 new VCCT sites established: 74 VCCT sites - in the public health sector 24 VCCT sites NGOs (RHAC, Center of Hope, K. Angkor Hosp) 5 VCCT sites Sun Health Quality Clinic (PSI) By end of December 2005 : 109 VCCT sites in all provinces By end of December 2006 : 150 VCCT sites in all provinces Plan by end of 2007: 200 VCCT sites

5 VCCT Sites, December December 2006 = 150 sites

6 Trend in number of people tested for HIV from 1997 to 2006 Number of people tested for HIV Average client-load per VCCT increased from 65 per month in 2003 to 165 per month in Years

7 Trend in number of people identified as HIV + through VCCT from 1997 to Number of people HIV Years

8 Quality of VCCT: 98.11% received their test results through post-test test counseling, Type of service ,000 90, , , , ,000 Number of people Pre-test Tested Post-test

9 Objective: Provider initiated HIV testing and counseling (PITC) To inform health care worker about the importance of HIV testing For health care workers to demonstrate the benefits of HIV testing to patients For health care workers to refer patients to VCCT centre To increase access of patients to VCCT

10 Guidelines for PITC implementation PITC is to be implemented in both the public and private sectors Emphasis to be on referral hospitals, FDH and health centers which provide VCCT Health care workers should inform patients of the benefits of HIV testing and refer them to VCCT with the appropriate referral card

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12 Number of 14 year old or younger children HIV tested and HIV+ in 2006 Total number of children HIV tested = Boy= Girl = 5202 Total number of children who received Post-test test counseling= Boy= Girl = 5122 Total number of children identified as HIV + = Boy= Girl =756

13 At risk children for whom HIV testing should be considered Children born to HIV positive mothers Children who are victims of sexual abuse Children who inject drugs Victims of child trafficking Children presenting clinical signs of HIV/AIDS Children who received blood or plasma transfusion

14 Strategies for Reaching at-risk children

15 Infant Diagnosis - DNA PCR Serology inappropriate due to presence of maternal antibodies PCR is diagnostic test of choice for neonates and breast feeding children born to HIV positive mothers

16 DNA PCR for Infant Diagnosis Testing algorithm For breastfeeding children (>= 6 weeks old) born to HIV+ mothers Negative PCR result = HIV -,, retest 6 weeks after stopping breastfeeding. Positive PCR result = HIV+ For formula fed children (>= 6 weeks old) born to HIV+ mothers Negative PCR result = HIV - Positive PCR result = HIV+

17 Benefits of HIV testing for children Early diagnosis Provide timely OI prevention and treatment Provide early ARV treatment Provide social support

18 Benefits of HIV testing for children (cont.)

19 Benefits of HIV testing for children (cont.)

20 Testing for HIV/AIDS Care and Treatment

21 CD4 testing Four FACSCount machines for absolute count were set up in August 2005 in: -Battambang RH -Takeo RH -Kampong Cham RH -NIPH A FACSCalibure machine for absolute count and percentage measurement was set up in July 2006 at NIPH Children under the age of 5 require measurement of CD 4 percentage Samples for pediatric patients that require percentage measurement should be referred directly to NIPH

22 Results of CD4 testing in 2006 Total CD4 for adult : samples - Batambang RH = Takeo RH = Kampong Cham RH = NIPH =18327 Total CD4 for pediatric : 3445 sample - PIC = NIPH = 2545

23 CD4 sample collection procedure Blood sampling must be carried out in clean room Blood must be collected in sterile K3 EDTA tubes 5 5 ml of complete blood should be collected Blood collected with K3 EDTA vacutainer tube and mixed well to avoid clotting of blood.

24 Potential sample problems preventing analysis Insufficient blood Blood clotting (micro clotting) Blood frozen during storage or transport to laboratory Mismatched sample ID on request form and tubes Sample collection in the incorrect tube type

25 Viral load testing Background: Commenced in the Faculty of Pharmacy in March 2006 (Laboratory RODOPHE MERIEUX) At NIPH started in October 2006 (Using Real-Time PCR and Roche Amplicor) Institut Pasteur started in 2005 Objective ; - Clinical management of ARV treatment in adults and children - Diagnosis for neonatal children born to HIV positive mothers

26 Viral load Indications for viral load testing: For patients displaying stages II, III and IV AIDS, after 6 months of ART In cases of poor CD4 increase (20-50 cells/mm 3 ) in patients receiving ARV for 12 months In cases of CD4 decrease from Baseline For breastfeeding children born to HIV + mothers (>= 6 weeks old) - Negative result = HIV- (Retest again after 6 weeks) - Positive result = HIV+ For formula fed children born to HIV + mothers (>= 6 weeks old) - Negative result HIV- - Positive result HIV+

27 Sample collection for Viral load Blood collected with EDTA K3 vacationer 5-10 ml Samples to be sent to the NIPH laboratory (contact Mr Mom Chandara) ) on ice within 6 hours of collection For long distance Pediatric AIDS care services blood sample should be spun, plasma collected in a micro-tube and stored in a refrigerator until sent to the laboratory on ice

28 Thank you