Objectives At the end of the lesson participants will be able to: Identify the types of HIV tests available in Botswana State who should be tested Identify which tests are used for infants and children at different ages State when re-testing is indicated Diagnosis and Testing of HIV in Infants and Children Teen Club Community Partners Training Programme Types of HIV Tests There are various forms of HIV tests The ones that are most commonly used in Botswana are: Rapid HIV test HIV ELISA Why are there different tests for different ages? Babies can carry maternal antibodies for up to 18 months after birth Since the rapid HIV tests or ELISA detect antibodies to HIV, they can tell us that the baby was exposed to HIV, but not that the baby is infected. DNA PCR detects the virus itself and therefore can tell us if there is HIV infection in a baby less than 18 months of age In Botswana, PCR is done at 6 weeks (at the time babies come for the first time to screening clinic) She passes these antibodies on to her baby during pregnancy or breastfeeding, even if the baby is not HIV infected Age Appropriateness of Tests An HIV positive mom makes antibodies against HIV Most babies who are born to HIV-infected mothers will not be HIV-infected, especially if they received PMTCT However, the babies will still have antibodies to HIV Rapid HIV tests and ELISA detect antibodies to HIV Breastfeeding and HIV Testing An HIV positive mom who breastfeeds her baby can transmit HIV virus to her baby at any point during breastfeeding A baby who has been breastfed by an HIV positive mom needs to have an HIV test 6 weeks or more after complete weaning 1
Breastfeeding and HIV Testing If the baby is less than 18 months old, the HIV test should be a DNA PCR test If the baby is more than 18 months, rapid HIV testing can be done How Testing Is Done Drops of blood are taken from the baby s heal, toe or finger for the rapid test or DNA PCR The drops are placed on the appropriate test For DNA PCR, the test paper is sent to the lab for testing For the rapid test, the tests are either processed immediately where the patient is or sent to the lab For the ELISA, blood is drawn and sent to the lab in a tube Timing of Diagnostic Tests for HIV exposed Infants Positive Send another PCR as Confirmatory test Yes Rapid HIV Test Yes Follow up 6 weeks after complete weaning Baby older than 18 months? Negative Breastfeeding? No No Confirm with rapid HIV test at 18 months Review Questions: 1. You are recommending an HIV test for a 6 week old HIV-exposed baby. What test should be done? 2. You are recommending an HIV test for a 3 year old boy whose mother recently died of an unknown illness. What would be the best HIV test for this child? Interpretation of Rapid Test Results DNA PCR positive negative 2
Which Children Should Be Tested For HIV? HIV exposed children: Babies born to HIV positive mothers Test routinely at 6 weeks of age Test after 6 weeks of age if it was not done at 6 weeks Children born to HIV positive mothers, regardless of age Babies and children who have been breastfed by an HIV positive woman Children whose mother s HIV status is unknown, especially if the mother is ill or deceased Who Should Be Tested for HIV? Children with a history of blood transfusion Children who have been sexually abused All children admitted to the hospital with unknown recent HIV status Remember, in Botswana HIV testing is ROUTINE and should also be recommended for Any mother, father or sibling of an HIV positive patient Any person who asks to be tested!!! Routine HIV Testing as Part of Comprehensive Health Care Remember, in Botswana we encourage every person to know their status. Testing is opt-out and determining HIV status should be a routine part of health care! When to Retest A baby who had a negative DNA PCR should retest with a rapid test or ELISA after 18 months Breastfed babies at least 6 weeks after weaning if initial HIV test was negative Any child who is ill or who is not growing or developing well Testing Scenario #1 A mother brings her 3 year old child to the health post for routine weight check. When you inquire about HIV status of the mom, she tells you she did participate in PMTCT. She says she has no concerns about her son because he has always been healthy and has grown well. Testing Scenario #1 Would you test this child? What type of test would you use? Remember to check and see if the child has already been tested. If not, testing is needed. Needs rapid HIV test. 3
Testing Scenario #2 An HIV positive mother comes for PCR results for her 3 month old baby. The results of the PCR test are negative but after talking with the mother you find that the child is breastfed. She chose to breastfeed the child because her husband s family does not know that she is HIV positive. Testing Scenario #2 What follow-up advice would you give? Does the baby need to be retested? If so, when should you retest and what kind of test would you use? Testing Scenario #2 The baby should have monthly weight checks and routine follow-up at the clinic. Better to do exclusive breastfeeding instead of mixed feeding (discussed later in nutrition lecture) Retesting can be done at any time if the baby is not thriving. If the baby is thriving, the final HIV test can be done 6 weeks after complete weaning. Which test to use depends on the baby s age: If <18 mos after weaning, use DNA PCR If >18 mos after weaning, do rapid HIV test or ELISA Testing Scenario #3 A 10 month old baby is admitted to the hospital with severe diarrhea. This is his second hospitalization for diarrhea. Mom is HIV positive, participated in PMTCT and the baby has received formula since birth. Would you test the baby and if so, what type of test would you send? If the baby had a negative DNA PCR at 6 weeks of age, would you still recommend testing now? Testing Scenario #3 Testing should be done now, even if previous test was negative, because the baby has severe recurrent diarrhea Test is DNA PCR Testing Scenario #4 You work in the clinic which provides ARVs to a mother and her 2 year old daughter. When you ask about other family members, she says that she has 2 other children ages 8 years and 13 years, but they are fine. She believes she was infected by the father of the younger child. 4
Testing Scenario #4 How would you counsel her regarding the testing of her other children? If you tested these children, which test would you use? Testing Scenario #4 The older children should still be tested because their HIV status is unknown. HIV-infected children can appear healthy for many years. Stress to the mother that the best time to know that a child is HIV positive is when the child is still healthy. That way, we can help keep the child healthy. Test is rapid HIV test or ELISA Testing Scenario #5 A 4 year old child is hospitalized with pneumonia. His mother tells you that she tested negative for HIV when she was pregnant with the child. Would you recommend testing for this child? Testing Scenario #5 This child should be tested. This child is sick. HIV testing should always be considered in people who are sick with something that might be HIV-related. The mom may have become infected with HIV late in her pregnancy or during breastfeeding after receiving her negative test. In this case, the child might have been exposed to HIV. We cannot be sure that the child did not have another HIV exposure such as through sexual abuse. THANK YOU Thank you to all our partners 5