Pediatric HIV Algorithm for Children aged 0-9 Months using PCR-DBS

The algorithm is intended for use in various healthcare settings, including antenatal care and prevention of mother-to-child transmission (PMTCT), pediatric inpatient and outpatient services, immunization clinics, voluntary counseling and testing (VCT) services, antiretroviral therapy (ART) clinics, nutrition clinics, and HIV/TB clinics. The algorithm is based on a rapid test and PCR-DBS (dried blood spot) test for the diagnosis of HIV in infants between 0-9 months of age. The entry point to care is determined by the presence of one or more symptoms listed in Chart A, or a known HIV-positive mother during pregnancy or breastfeeding period. In such cases, a PCR-DBS test is recommended by 6 weeks of age. Chart A outlines the presumptive diagnosis of HIV infection in children based on clinical signs, including unexplained severe wasting or severe malnutrition, unexplained persistent diarrhea, unexplained fever, oral candidiasis, cough not responding to treatment, recurrent severe bacterial infections, chronic labial herpes simplex infections, recurring skin infections, and a history of maternal HIV. The presence of one or more of these signs and symptoms leads to a presumptive diagnosis of HIV and the application of recommendations in Chart B. Chart B provides recommendations for PCR or rapid test-positive children, including the administration of cotrimoxazole to prevent opportunistic infections, scheduling follow-up visits to monitor side effects and ensure the child is not lost to care, confirming HIV infection with serological tests at 9 months, referring for clinical staging and assessment for ART eligibility, counseling parents on infant feeding, advising on home care, continuing immunization schedules, counseling parents on their own HIV status, and linking parents and child to support groups. Chart C outlines recommendations for PCR or rapid test-negative children, including treating other diseases, counseling parents and following up on any child concerns, advising on infant feeding, counseling parents on their own health, counseling parents on how to remain HIV-negative, and counseling parents on birth spacing and family planning. The algorithm also includes the "AFASS" criteria for stopping breastfeeding in HIV-exposed infants, which considers the mother's perception of no problem in replacement feeding, the mother's ability to adequately time, knowledge, skills, resources, and support to correctly mix formula or milk and feed the infant, the affordability of replacement feeding without harming the health and nutrition of the family, the sustainability of a continuous supply of all ingredients needed for safe replacement feeding, and the safety of replacement foods being correctly and hygienically prepared and stored.