According to UNAIDS, Ethiopia has made significant progress in the fight against HIV/AIDS in recent years. The country has increased access to antiretroviral treatment and implemented prevention programs to reduce new infections. However, challenges remain, such as stigma and discrimination against people living with HIV, particularly in rural areas.

Efforts are being made to address these challenges and improve the quality of life for those affected by HIV/AIDS in Ethiopia. Community-based organizations and government agencies are working together to provide comprehensive care and support services, as well as education and awareness campaigns.

Childhood HIV remains a significant concern in Ethiopia, with many children being born with the virus each year. Early diagnosis and treatment are crucial in ensuring the health and well-being of HIV-positive children. Health care providers in Ethiopia are working to improve access to pediatric HIV testing and treatment services to reach more children in need.

Support from organizations and donors has been instrumental in expanding services and resources for childhood HIV care in Ethiopia. Through efforts to increase testing, provide medication, and offer support to families, progress is being made in addressing this important issue.

Challenges in Ethiopia

The Impact of HIV/AIDS on Children

With 2.4% HIV prevalence, Ethiopia faces significant challenges in dealing with the HIV/AIDS epidemic. Over a million adults and 79,000 children under 14 are living with the virus. Despite the need for antiretroviral therapy for over 26,000 children, only a fraction receive treatment, leading to high mortality rates.

Children mainly contract HIV from their mothers, but not all infected mothers transmit the virus. Approximately 35% of children born to HIV-positive mothers become infected.

Health Extension Practitioners play a vital role in identifying and caring for HIV-infected children, who often suffer from various infections and malnutrition.

This session focuses on assessing potential HIV infection in children and providing appropriate care.

Learning Objectives

By the end of this session, participants should be able to:

• Understand and use key terms related to HIV/AIDS
• Assess and categorize children for HIV infection
• Offer initial treatment, advice, and referrals following guidelines
• Counsel mothers on HIV testing

Building Relationships and Assessing Children

Establishing trust and maintaining confidentiality is crucial when supporting mothers of HIV-positive children. Effective communication can help gather necessary information for the child’s care.

When evaluating a child for HIV infection, consider the mother and child’s HIV status, symptoms, and risk factors before deciding on testing.

Refer to the assessment steps in Box 9.1 for guidance.

Box 9.1: Steps to Assess for HIV Infection

Learn how to conduct and interpret HIV tests.

Testing for HIV Infection

Diagnosing HIV in children involves serological and virological tests. Positive results confirm infection, with repeat tests often necessary. Sensitive communication is key when discussing test results with mothers.

Address questions about HIV testing based on results and child’s age.

Common Illnesses in HIV-Infected Children

This section highlights key infections in HIV-positive children like pneumonia, persistent diarrhea, ear discharge, malnutrition, and oral thrush.

Pneumonia

Pneumonia poses a significant risk to HIV-infected children, requiring prophylactic measures to prevent complications.

Persistent Diarrhea

Timely identification and treatment of diarrhea are crucial for HIV-infected children.

Ear Discharge

Proper management of ear infections is needed for children with symptomatic HIV.

Malnutrition

Nutritional support is essential for HIV-infected children experiencing malnutrition.

Oral Thrush

Oral thrush, caused by Candida fungus, is a common condition in HIV-positive children, affecting swallowing.

Additional Signs of HIV Infection

Bilateral parotid enlargements and persistent lymph node enlargement are indicative of HIV infection in children.

After assessment, categorize the child based on findings.

Classifying Children for HIV Infection

Refer to Table 9.1 for the different classifications based on test results and symptoms.

Understand the distinctions between confirmed symptomatic HIV infection, confirmed HIV infection, suspected symptomatic HIV infection, possible HIV infection, and unlikely HIV infection.

Support and Treatment for Infected Children

Children classified with HIV infection should receive cotrimoxazole prophylaxis, referrals for ART, vitamin supplements, feeding advice, and home care guidance.

Initiating Prophylaxis

Start cotrimoxazole prophylaxis early to reduce infections and mortality in HIV-infected children.

Cessation of Prophylaxis

Continue cotrimoxazole prophylaxis as long as the child lives, adjusting treatment based on conditions.

Counseling Mothers

Empower mothers of potentially infected children with information on HIV testing, counselling, testing, nutrition, and hygiene practices.

Improving Child Health

Assure mothers that effective interventions can improve their child’s health and well-being. Emphasize the importance of confidentiality when discussing HIV-related matters.

Key Takeaways

Summarize the key points learned, including initial treatment protocols and counselling strategies for HIV-infected children.

Assessment and Review

Assess your understanding of the learning outcomes by answering questions and referencing self-assessment notes. Engage with Case Study 9.1 for practical application.

Case Study 9.1 for Practical Application

Assess and classify Gizaw, an 18-month-old child presenting with diarrhea, for possible symptomatic HIV infection. Answer the questions for self-assessment.

Self-Assessment Questions

• a. Identify Gizaw’s symptoms
• b. Classify Gizaw for HIV infection and justify your classification
• c. Propose a treatment plan for Gizaw

Answer

• a. Gizaw is suffering from moderate acute malnutrition along with diarrhea. Additionally, he is experiencing oral thrush and has enlarged parotid glands.
• b. Gizaw’s condition is confirmed as symptomatic HIV infection.

Case Study 9.2 Analysis for SAQ 9.2

Rediet, a six-month-old infant weighing 7 kg, has a body temperature of 36.8°C. She was brought to the healthcare facility by her mother due to a persistent four-day cough.

No critical warning signs were observed during the assessment.

After evaluating her for pneumonia-related symptoms, it was found that she had a cough and was breathing at a rate of 54 breaths per minute. There were no signs of chest wall in-drawing or stridor. Hence, she was classified as a pneumonia case.

There were no indications of diarrhea, fever, or ear issues during the examination.

Rediet was also checked for malnutrition and anemia, but no severe wasting, palmar pallor, or foot edema was detected. Her Mid-Upper Arm Circumference (MUAC) was measured at 11.5 cm.

It was revealed that Rediet’s mother had tested positive for HIV during her pregnancy. Rediet herself displayed oral thrush, but did not have enlarged lymph nodes or parotid gland enlargement.

SAQ 9.2 Tasks (testing Learning Outcomes 9.1 and 9.2)

• a. Document the signs observed in Rediet.
• b. Determine Rediet’s classification for HIV infection.
• c. Provide counseling to Rediet’s mother.

Responses

• a. Rediet is diagnosed with pneumonia and oral thrush. Her mother has tested positive for HIV.
• b. Rediet is classified as having suspected symptomatic HIV infection.
• c. Offer guidance to the mother on Rediet’s treatment.

SAQ 9.3 (assessing Learning Outcomes 9.3 and 9.4)

Effective communication and counseling skills are vital when advising a mother of a child potentially infected with HIV.

Responses

The sensitive nature of discussing HIV can lead to secrecy. Establishing trust with the mother is essential for testing, childcare, and family-wide prevention measures.