Overview

HIV/AIDS affects the health and welfare of children and undermines hard-won gains in child survival in some of the highly-affected countries. The 'Manual on paediatric HIV care and treatment for district hospitals' aims to help improve clinical skills among health workers in resource-limited settings. It is intended for use by doctors, middle-level practitioners such as clinical officers and senior nurses in the management of HIV-exposed and -infected infants and children at district hospital levels.

The manual consists of two parts. The first part deals with the management of HIV-infected children when they present with common illnesses and opportunistic infections: cough or difficult breathing, diarrhoea (acute and persistent), fever and malnutrition, anaemia and other haematological manifestations. The second part of the manual covers HIV specific management including diagnosis of HIV infection in infants and children, routine care of HIV-exposed and -infected children, antiretroviral therapy, nutritional support, pain management as well as disclosure and psychosocial support.

Contents

• Development Process
• Acknowledgements
• Introduction to manual
• Part I. Common childhood illnesses in HIV-exposed and infected children
  • 1. Cough or difficulty breathing in HIV-exposed and HIV-infected children
    • 1.1 Approach to cough or difficulty breathing for the HIV-infected child
    • 1.2 Differential diagnosis table of an HIV-infected or HIV-exposed child with cough or difficulty breathing
    • 1.3 Pneumonia in HIV-infected or exposed children
    • 1.4 PCP (Pneumocystis jiroveci pneumonia)
    • 1.5 Lymphoid Interstitial Pneumonitis (LIP)
    • 1.6 Pulmonary Tuberculosis in HIV-infected/exposed children
    • 1.7 Bronchiectasis
    • 1.8 Cytomegalovirus (CMV) Infection
    • References for further reading
  • 2. Diarrhoea and other gastrointestinal problems in HIV-infected children
    • 2.1 Diarrhoea
    • 2.2 Hepatitis in HIV-Infected child
    • References for further reading
  • 3. Fever in the HIV-Infected child
    • 3.1 Approach to fever in an HIV-infected child
    • 3.2 Sepsis
    • References for further reading
  • 4. Malnutrition and anaemia including hematologic manifestations
    • 4.1 Malnutrition
    • 4.2 Anaemia
    • References for further reading
• Part II. Paediatric HIV care and Treatment with ART
  • 5. Introduction: Infants, children and HIV-infection
    • 5.1 Key differences between adults and children
    • 5.2 Epidemiology
    • 5.3 Modes of Transmission
    • 5.4 Immunology
    • 5.5 Natural History and Progression
    • References for further reading
  • 6. Diagnosis of HIV infection in infants and children
    • 6.1 Early identification of HIV infected infant or child
    • 6.2 Diagnosis of HIV-infection in children
    • 6.3 Counselling
    • 6.4 Diagnosis of HIV under special conditions
    • References for further reading
  • 7. Routine care for HIV-exposed and infected infants and children
    • 7.1 Immunizations
    • 7.2 Prophylaxis
    • 7.3 Nutrition
    • References for further reading
  • 8. Antiretroviral Therapy (ART)
    • 8.1 When to start ART for infants and children
    • 8.2 When to initiate ART in HIV-infected Infants AND CHILDREN UNDER 24 MONTHS (WHO 2010 recommendation)
    • 8.3 When to initiate ART in HIV-infected children 24 months of age and older
    • 8.4 ART drugs
    • 8.5 Clinical and Laboratory Monitoring
    • 8.6 Adherence
    • 8.7 ARV drug toxicity
    • 8.8 IRIS: Inflammatory immune reconstitution syndrome
    • 8.9 Substituting drugs because of toxicity in infants and children
    • 8.10 Choice of second-line regimens in the event of treatment failure
    • References for further reading
  • 9. Nutritional Support
    • Key Practices for Infant and Young Child Nutrition
    • 9.1 Special Considerations for HIV Infection
    • 9.2 Prevention of mother-to-child-transmission (MTCT) of HIV via breast feeding
    • 9.3 Increased energy requirements of HIV-infected children
    • 9.4 Steps For Assessing Child Feeding And Counseling The Caregiver
    • 9.5 Management of a severely malnourished child with HIV infection
    • References for further reading
  • 10. Pain Management in HIV-infected children
    • 10.1 Recognition and assessment of Pain in children
    • 10.2 Managing pain in children
    • References for further reading
  • 11. Disclosure and psychosocial support for children
    • 11.1 Disclosure
    • 11.2 Adherence to treatment
    • 11.3 Psychosocial support for HIV-infected children
• Annexes Paediatric ART drug formulations and dosages

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