Devpro Resource Centre
Early diagnosis of HIV in infants
‘Loud and clear’
Providing treatment to all children who need it will require reaching the youngest among them – those under one year old. Very few HIV-positive babies are receiving treatment, and without it, one third of them will die before their first birthday. Early diagnosis of HIV puts babies on the path to life-saving treatment.
Many countries are rapidly building national capacity for infant diagnosis – expanding these programmes in most countries will require strengthening health systems overall. Early diagnosis and treatment of HIV in infants is an essential component to realizing child survival around the world.
As a practitioner, decision maker or donor, we ask you to help ensure that the 1,000 children who are newly infected with HIV every day realize their right to a healthy future.
This issue-based message video highlights the case for early infant diagnosis and lays out the path to making it happen. Please feel free to use it in your outreach, communication and advocacy efforts with partners in civil society, government and academia.
WHAT DOES THE PATH TO EARLY INFANT DIAGNOSIS AND TREATMENT LOOK LIKE?
IDENTIFY all babies born to mothers living with HIV
Every year, large numbers of children continue to be infected with HIV before they are born, at delivery or when breastfeeding. Many children born to women with HIV are not being systematically monitored, and some children are identified as infected with HIV only when they become very sick.
For children born to mothers living with HIV, there are no clear data on how many of them were tested early, how many of them tested positive, or how many actually began antiretroviral therapy.
TEST them within two months of birth
In 2007, only 8 per cent of infants born to women with HIV were tested within the first two months of their life. Babies need a special type of test that relies on detecting the HIV virus – it is different from the standard antibody test for adults and older children. With just a prick of the heel, it is possible to collect a blood sample on filter paper and transport it to a laboratory with the capacity for this type of testing.
In many countries, scaling up early testing will require strengthening laboratory capacity, providing equipment, ensuring a reliable supply of reagents, and training service providers.
COMMUNICATE the results right away
Time is of particular importance for HIV-positive babies. Because of the special testing methods needed for babies, which can include transporting blood specimens to laboratories with appropriate equipment, it is important to build effective networks so that results can be communicated between the laboratory, the clinic, and the family or caretaker in a timely and cost-effective manner.
There is a need to develop and use innovative mechanisms, such as mobile phones, to reach families when test results are positive. Establishing networks that effectively link diagnosis with care are also of utmost importance.
Learn how testing networks are working in Kenya (see page 5).
TREAT babies who have HIV immediately
For babies with HIV, starting treatment within the first 12 weeks of life can reduce their chance of dying by three quarters. Conversely, waiting to start treatment may mean that a child’s immune system is already severely compromised. The World Health Organization (WHO) now recommends that all HIV-positive infants under one year old should start antiretroviral therapy, irrespective of clinical or immunological stage.
Where necessary, review national policies to include guidelines and targets for early diagnosis and treatment of HIV in babies. Infants diagnosed with HIV will require new, fixed-dose combination medicines appropriate for the youngest populations.
FOLLOW UP and ensure continued care
Experience from South Africa shows that without a structured plan that includes early testing, the vast majority of children born to HIV-positive mothers attending prevention of mother-to-child transmission clinics were lost to follow-up. Following up with children who have been exposed to HIV is necessary not only to ensure timely treatment and care, but to avoid post-partum transmission of the virus and to improve the overall health of babies and families as well.
Integrating HIV and AIDS services within existing health infrastructures can help reach more children and women with comprehensive interventions, including HIV testing for mothers and exposed infants, support and counselling on safe feeding and initiation of cotrimoxazole.
Unite for Children, Unite against AIDS, ‘Briefing Paper: Scaling up early infant diagnosis and linkages to care and treatment’, 2009 | PDF
UNICEF, UNAIDS, WHO and UNFPA, Children and AIDS: Third stocktaking report, 2008 | Download
WHO and UNICEF, Scale up of HIV-related prevention, diagnosis, care and treatment for infants and children: A programming framework, 2008 | PDF
WHO, UNAIDS and UNICEF, Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector, 2008 | Download
Actions for Children
WHO and UNICEF recommend exclusive breastfeeding for infants of mothers with HIV for the first six months of life unless replacement feeding is acceptable, feasible, affordable, sustainable and safe. Read more...
WHO recommends that all HIV-positive infants under one year old should start antiretroviral therapy, irrespective of clinical or immunological stage. Read more...
Organizations working to ensure treatment and care for children living with HIV:
UNAIDS (Joint United Nations Programme on HIV/AIDS)
WHO (World Health Organization)
UNFPA (United Nations Population Fund)
BIPAI (Baylor International Pediatric AIDS Initiative)
ICAP (International Center for AIDS Care and Treatment Programs)
If you would like to add your organization here please send us an email: