Answer Key: Module II: Diagnosing and Testing

Using the Testing Algorithm

#1. Why and when would you perform a rapid test on an infant?

Why? To determine the infants exposure status

When? When the mother’s status is unknown, and there is no way of testing her. (please note that the algorithm is for children under 18 months)

#2: You have a confirmed HIV+ mother who is still breastfeeding, and the exposed infant’s first PCR was negative, what should you do next and when?

Do a 2nd DNA PCR 6 weeks after stopping breast feeding

If the child has signs and symptoms of HIV you should not wait for the child to stop breast feeding, but should take of DNA PCR sample immediately

#3. Is one positive PCR test enough to start a child on ART?

Yes. If the child is exposed and the first DNA PCR is positive, initiate ART. Remember to take off another DNA PCR as you initiate the ART.

Case Study Practice: Diagnosing and Testing

Case #1: A 3.5 month old child comes to YCC for immunization.

a)How do you go about determining the exposure status of the child?

  • Check the child health card for mother’s HIV status
  • Check mother’s ANC card for mother’s HIV status
  • Perform rapid rapid test on mother if her HIV status is unknown
  • Perform rapid test on infant if mother unable to test mother

b)If the child is HIV exposed what test do you do?

  • Do a DNA PCR test
  • Start co-trimoxazole

c)If the test is positive what would you do?

  • Initiate ART and take off 2nd PCR on the day child starts ART

d)If the test is negative what would you do?

  • Ascertain if child has breast fed within last 6 weeks of 1st PCR

If breast feeding,

  • Recommend mother to continue breast feeding until child is 12 months, and then do 2nd DNA PCR 6 weeks after stopping breast feeding. Child should receive ARV prophylaxis during breastfeeding until one week after cessation of breastfeeding.
  • Do 2nd DNA PCR if child is symptomatic

If did not breastfeed

  • Manage as HIV negative. DONE

Case #2: You have a 2 year old child who presents in OPD with oral thrush.

a)What test would you use to diagnose HIV in this child?

  • Rapid test (this is because by 18 months we expect the maternal antibodies to have disappeared)

b)If it is negative what would you do?

  • Manage as HIV negative
  • Treat oral thrush
  • Repeat rapid test after 4 weeks because the child has signs of HIV (oral thrush)

Emphasize that the child should be started on ART basing on clinical stage criteria (stage 3; oral thrush) not basing on the age criteria. It is only the under 2 yr old children who are started on ART irrespective of CD4 or WHO clinical stage.

c)If it is positive what would you do?

  • Stage the child. (is in stage 3)
  • Counsel the care giver to prepare for ART
  • Start co-trimoxazole prophylaxis