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Management, Care for infants who were born from infected mothers

Management, Care for infants who were born from infected mothers. HAIVN Harvard Medical School AIDS Initiatives in Vietnam. Learning Objectives. By the end of this session, participants should be able to: Describe the process of management and care for exposed / infected children

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Management, Care for infants who were born from infected mothers

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  1. Management, Care for infants who were born from infected mothers HAIVN Harvard Medical School AIDS Initiatives in Vietnam

  2. Learning Objectives By the end of this session, participants should be able to: • Describe the process of management and care for exposed/infectedchildren • Define OI prophylaxis, immunization and neededlab tests for exposed and infectedchildren

  3. Overview

  4. Diagnosis of HIV infection • Most children born from HIV-infected mothers are carrying maternal antibodies • Maternal antibodies will be gradually eliminated in the first 18 months • Children are confirmed HIV infection if still having HIV antibodies after first 18 months • Diagnosis of HIV infection in infants • >18 months: ELISA • <18 months: PCR

  5. Importance of management and care for children born fromHIV-infected mothers Management of childrenat OPC can help: • Reduce the mortality • HIV-infectedchildren have the mortality up to 50% in the first 18 months of their life • These children should be developed and grew as other normal children. Note: differentiate between infected and exposed infants

  6. Management of exposed children

  7. Management of exposed children

  8. Receiving children • Making medical outpatient chart for HIV exposed infants • Writing the child's name in the logbook for monitoring HIV-exposed infants

  9. Clinical and laboratoryassessment (1) Clinical assessment at the first time when register and every follow-up visit: • General condition, clinical symptoms • Physical, mental, and cognitive development • Immunization • Current medications, side effects (if any) • OI diagnosis and treament (if any)

  10. Clinical and laboratoryassessment(2) Lab test: Indicate as soon as possible appropriate test to confirm HIV statusaccordingly to theirage group. • PCR: 4-6 weeks • ELISA: ≥ 18 months

  11. Counseling and support • Determine who are the main and supportive care givers for the infants • Family and care giversshouldbecounseled on: • Doing HIV confirmative testing for infants. • Immunization and OI prophylaxis for infants • Risk of HIV infection throughbreastfeeding • Psychological and social support • Introduce HIV care and treatment service • Supportive solutions for orphaned and abandoned infants

  12. Management • Provide OI prophylaxis with Cotrimoxazole • Provide treatment for OIs, symptoms, and other conditions (if any) • Admit to hospital with severe cases • Seek for consultation from or refer patients to relevant facilities if beyond treatment capacity

  13. Follow-up plan and otherneccessary supports • Confirmative diagnosis by testing as soon as possible • Schedule follow-up visit • For infants missingvisit, find out the reasons and establishsupportive solutions. • Schedule visitswheneverabnormallitiesoccur. • Dispense drugs as prescribed. • Coordinate the supports from family and community with available services.

  14. Management of infected children

  15. Small Group Discussion Things should be done at the OPC in order to manage well HIV-infected children

  16. Management of infected children

  17. Receiving children • Making medical outpatient chart for HIV infected infants • Writing the child's name in the logbook for monitoring HIV-infected infants • Provide out-patient card for infants (if any)

  18. Clinical and laboratoryassessment (1) Clinical assessment at the first time when register and every follow-up visit: • General condition, symptoms, clinical and immunological stages • Physical, mental, and cognitive development • Immunization • Current medications, side effects (if any) • OI diagnosis and treament, screening of TB and other conditions.

  19. Clinical and laboratory assessment (2) Lab tests: • Complete blood count, Total lymphocyte count, ALT: • At the first visit • Every 3-6 months • CD4: • Every 3-6 months or • Infants with severe progress • Other necessary tests

  20. Counseling and support Similar to exposed children, and add more issues on: • The progress of HIV infection, importance of long-term care and treatment • The need of: • Clinical monitoring • Doing lab tests to assess the progress of HIV infection • Counseling should be focused on: • Disclosure of HIV status of infants to family’s members • Preventive measures of HIV transmission • Safe behaviors practice

  21. Management (1) • Provide OI prophylaxis with Cotrimoxazole • Provide treatment for OIs, symptoms, and other conditions (if any) • Assess criteria of ARV treatment: • Not eligible : making long-term plan to follow • Eligible: preparing readiness for ARV treatment • Already on ARV: • Perform the process of follow-up visit • Re-assess, consult to choose proper regimen if infants referred from other places.

  22. Management (2) • Admit to hospital with cases: • Complicated OIs • Severe side effects • Seek for consultation from or refer patients to higher level if beyond treatment capacity • Coordination with specialized facilities (TB, dermatology & venerology, etc.)

  23. Follow-up plan and otherneccessary supports • Making specific schedule of follow-up visits for every infant: 1-2 months/time • For infants missingvisit, find out the reasons and establishsupportive solutions. • Schedule visitswheneverabnormallitiesoccur. • Dispense drugs as prescribed. • Coordinate the supports from family and community with available services.

  24. Immunization

  25. Brainstorming

  26. Vaccinations • Widely used across the country : • BCG • Hepatitis B • Diphtheria - Pertusis - Tetanus (3-vaccine combination) • Poliomyelitis (orally) • Measles • Encephalitis due to H. influenzea type b (5-vaccine combination) • Japanese encephalitis • Optional vaccine: • Encephalitis due to H. influenza type b (single or combined vaccine) • Varicella, mumps, rubella…

  27. Vaccines under the National Expanded Program on Immunization

  28. Optional Vaccine

  29. Một số lưu ý khi tiêm chủng • All HIV-exposed children should receive BCG. Postpone vaccination until HIV infection is excluded in following situations: • High risk of HIV infection: mother and infant not receiving PMTCT • Signs or symptoms suggestive of HIV infection • Having symptoms or conditions of clinical stage IV • Low birth weight < 2500g,or was born pre-term • After vaccination, it could have swollen lymphonode, enlarged liver and spleen, and cachexia. Consultation with TB specialists.

  30. Key Points • HIV infected children have mortality rates up to 50% in the first 18 months of life • For HIV exposed/infected infants/children need to comply with the process of care management: • Receive • Clinical and laboratory assessment • Management • Supportive counseling and monitoring • Need to counsel for care givers on the importance of immunization and monitoring closely its schedule

  31. Thank you! Questions?

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