August marks Child Health Month, and our focus this year is testing children and teenagers for HIV.
Amanda Ndlangisa sat down with Dr Melanie Collins, Technical Advisor: Paediatrics and Adolescents at Anova Health Institute, who highlights the importance of people knowing their HIV status, especially children.
Why is it important for children to test for HIV?
Everyone should regularly test for HIV so that those who are infected can access life-saving antiretroviral therapy (ART). It is especially important to test children for two reasons. Firstly, because many parents and clinicians avoid testing children for HIV, for various reasons, and as a result the diagnosis might only be made late when the child is already very ill and secondly because children generally get sicker quicker from HIV infection compared to adults. Severe illness from HIV can be avoided with early diagnosis and starting ART as soon as possible. If we do not test, we cannot treat.
Please explain the process of testing children for HIV at birth.
Only children born to HIV infected mothers are routinely tested for HIV at birth. These babies follow the following testing schedule: Birth, 10 weeks, 6 months, 18 months and 6 weeks after they stop breastfeeding. The testing times are designed to co-inside with immunisations so it does not involve an extra trip to the clinic. If at any point the test is positive, ART will be started and no further HIV testing will be done.Important to note, that since 2019, all children, even those born to HIV negative mothers should be tested at 18 months to make sure that no children are missed.
If my child previously tested negative for HIV, is there still a need to test them again?
Yes, especially if mom is known to be HIV positive or does not know her own status or if the child has any signs or symptoms suggestive of HIV. It is possible for children to test positive later in life due to the window period or previous false negative results, although rare. Often the assumption is that there must have been a sexual assault, and although this needs to be investigated, it does not automatically mean that this has occurred. Children can be exposed to HIV in other ways such as wet nursing or coming into contact with infected blood, although this is very rare it is still possible, so one should never assume that a child in HIV negative, it is always better to test.
What happens if my child/teenager then tests positive?
The first steps include explaining the result and repeating the test. The child will then be referred to a nurse or doctor who will examine and take extra blood tests (CD4 count and full blood count) and start ART. The family will be asked for a follow up in 1 to 2 weeks to check results. This is also a good opportunity for continued counselling and for parents to ask questions as the first visit is often overwhelming for parents.
Is the HIV treatment for children the same as adults?
The basic principles of HIV treatment for children and adults are the same. Children may get a slightly different combination of medications and depending if the child can swallow tablets or not will vary between syrups or tablets and may be once a day or twice a day depending on the treatment. These treatments will adjust and change as the child gets older and gains weight with the hope of eventually moving to one tablet a day. There is also lots of research looking at long-acting injectable options and implants which would then remove the need to take ARVs in tablet form – but that is still a little way away.
What would you say to a parent who is hesitant about testing their children for HIV?
Please take yourselves AND your children to be tested for HIV! I know that the thought of possibly testing positive for HIV is very scary because of the continued stigma and fears that it inevitably leads to death, but that is simply not true anymore. HIV is a manageable chronic condition and people who are on appropriate treatment and take treatment well live long and healthy lives. I also hope to see the end of the unnecessary stigma that surrounds HIV.
In my opinion, the only tragedy is never knowing your HIV status or the HIV status of your children because then life-saving ARVs are never started.
Early detection and treatment saves children’s lives. Ask your healthcare worker about testing your child today.