Nursing Care for HIV - Nursing Care of Children

Authors: Talitha Crowley, MCur, PGDip Primary Health Care, PGDip Nursing Ed, BCur; Susan Strasser, MPH, MSN, PhD
Editors In Chief: Ian M. Sanne, MBBCH, FCP(SA); Stacie Stender, MSN, MSc ID, FNP (More Info)

Last Reviewed: July 8, 2016 (What's New)

Credit Information

inPractice® Africa’s Continuing Education Unit (CEU) provider, the South African Medical Association, does not offer CPD points for this individual module, but all participants who complete the module with a 70% pass rate will receive a participation certificate. To learn more on CPD credits and participation certificates, click here.

Introduction

  • South Africa has a well-established prevention of mother-to-child transmission (PMTCT) programme
    • More than 95% of women access PMTCT antiretroviral therapy (ART) in pregnancy[Goga 2012]
    • A cross-sectional facility-based survey conducted in 2011 at immunisation points at primary healthcare/community health centres in all 9 provinces found a national MTCT rate of 2.7% at 6 weeks[Goga 2012]
  • Although MTCT rates have decreased dramatically, more work needs to be done, particularly in supporting women to adhere to ART in the long term as well as identifying women who seroconvert late in pregnancy or during breast-feeding
  • Therefore, although many pregnant women access therapy, it does not always translate into adequate prophylaxis of exposed infants or early treatment of infected infants
  • To reduce mortality, PMTCT must include early identification and initiation of treatment for those infected
  • According to StatsSA Midyear Population Estimates 2015, infant mortality is 34.4/1000 live births and the mortality for children younger than 5 years of age is 45.1/1000, decreased from 2009 (56/1000)[StatsZA Midyear 2015]
    • The 2015 Millennium Development Goal target for mortality of children younger than 5 years of age was 20/1000 live births[ZA NDOH CARMMA 2015]
    • Sustainable Development Goals for South Africa are being drafted
      • The United Nations’ goal is: “By 2030, end preventable deaths of newborns and children younger than 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 live births”[UN 2015]
  • The most common causes of mortality in children younger than 5 years of age in South Africa[ZA NDOH CARMMA 2015]
    • AIDS-related deaths, including tuberculosis (40%)
    • Deaths during the neonatal period (18%)
    • Diarrhoeal disease (11%)
    • Pneumonia (6%)
    • Severe malnutrition (5%)
  • Undiagnosed tuberculosis is clearly a major contributor to significant mortality in children younger than 5 years of age
  • HIV remains a major driver of both morbidity and mortality
  • The following updates were implemented to benefit the treatment of children in the 2015 South Africa National Department of Health HIV treatment guidelines:
    • HIV-exposed children < 5 years of age should be tested and all of them treated if found to be HIV-infected (Management Guidelines)[ZA NDOH HIV Tx 2015]
    • Birth HIV polymerase chain reaction (PCR) testing of all HIV-exposed neonates, repeated at 10 weeks
    • Immediate initiation of infant ART with first positive HIV PCR while waiting for confirmatory test results
      • A positive second HIV PCR test confirms HIV
    • Viral load is no longer taken at baseline but 6 months after initiation of ART
    • For those on extended 12-week nevirapine prophylaxis, the PCR will be repeated at 18 weeks and a rapid HIV test at 18 months
      • Rapid HIV testing is the appropriated HIV test starting at 18 months