Managing HIV/AIDS in children

With no treatment policy for HIV positive children in place, existing health and social interventions that can improve the life of a child living with HIV/AIDS are not being adequately implemented in state clinics around South Africa, a study has found. Despite the government's release of a set of comprehensive guidelines entitled "Managing HIV in Children" in March 2000, only 20 percent of the clinics interviewed had knowledge of them. The guidelines were intended to provide health staff with information on the administration of one or more of the interventions. The University of Cape Town's Child Health Institute conducted the study, which looked at whether clinics provided cotrimoxazole as a prophylaxis to prevent pneumocystis carinii pneumonia (PCP) in children. PCP is a major cause of morbidity and mortality in young infants who are HIV positive and the World Health Organisation guidelines recommend that all HIV-exposed infants be given prophylaxis from 6 weeks to 4 months of age. Of the 383 clinics interviewed, 40 percent reported not administering cotrimoxazole to HIV-positive children at all. The clinics reported that they had no guidelines for dispensing the drug, while 9 percent did not have the drug. In most of the clinics, HIV-positive children were directly referred to a doctor or a hospital. A lack of capacity and knowledge of how to deal with children were cited as the main reasons. "The situation will hopefully improve when the prevention of mother-to-child transmission intervention rolls out to all the districts in the country. This programme allows for the early identification and follow-up of the HIV-exposed infant, including cotrimoxazole prophylaxis from 6 weeks of age," the study noted. Another failure of the clinics was not to provide vitamin A supplements. "Vitamin A supplementation in HIV-infected children has been associated with reduced morbidity, particularly in relation to diarrhoeal disease, reduced mortality and improved immune function," the study said. Nationally, 35 percent of the clinics reported that they routinely administered vitamin A to HIV-positive children. Of the 130 clinics where vitamin A was dispensed, less than a quarter prescribed the correct regimen for HIV-infected children. According to the study, one of the major obstacles in implementing the vitamin A supplementation had been the availability of vitamin A capsules. Another recommended intervention by the government was the follow-up on children living in homes where an adult had been diagnosed with tuberculosis (TB). Most of the clinics reported some system for follow-up visits, and more than half reported administering TB treatment for children. But only 19 percent were providing the correct regimen according to the National TB Control Programme recommendations. The impact of HIV/AIDS on childhood malnutrition created a "vicious cycle" that undermined the health of the infected child, the study said. The majority of the clinics reported that HIV-positive children were included on the clinic's Protein Energy Malnutrition scheme (PEM). Irregular supplies of porridge and formula was, however, a problem. For those clinics that participated in the scheme, maize meal and beans were commonly used as alternatives. Children living with HIV/AIDS in conditions of poverty are at greater risk of contracting and dying from opportunistic infections and malnutrition. Poverty alleviation measures are a critical component of any HIV/AIDS intervention. While there are no special provisions for children infected by HIV/AIDS, caregivers can access some support in the form of government-provided child support grant. But lack of knowledge of available grants and administrative hurdles make accessing the grants difficult. Public sector clinics provided an opportunity for service providers to provide information on the existence of relevant grants and to advise them on how to access them, the study found. The vast majority of the clinics (73 percent) reported that they referred clients elsewhere for advice and assistance with accessing a social security grant. The study called for training of primary health care staff on the appropriate management of HIV in children "The regular supply of necessary drugs and supplements are essential for the successful implementation of existing policy and guidelines," the study concluded. More information