Key Features

• Positive DNA PCR test confirms HIV infection in an infant.
• Requires urgent initiation of lifelong ART.
• Requires co-trimoxazole prophylaxis starting at 6 weeks.

Classification

• Infant has positive virological test (DNA PCR) -> CONFIRMED HIV INFECTION

Usimamizi

Non-Pharmacological Management

• Link infant URGENTLY to HIV Care/ART clinic for initiation of Antiretroviral Therapy.
• Assess feeding and provide appropriate counselling (balancing benefits of breastfeeding with transmission risk, supporting safe replacement feeding if chosen/appropriate - follow national guidelines).
• Assess for TB.
• Provide psychosocial support to mother/family.

Pharmacological Treatment

• Start Co-trimoxazole prophylaxis from 6 weeks of age (or immediately if diagnosed after 6 weeks). Dose: Age 6 weeks - 6 months: 2.5ml syrup (or 1 infant tab) daily. Continue lifelong.
• Initiate ART as per national guidelines under specialist care.
• Treat any current illness according to IMCI guidelines (be aware of increased severity risk).
• Ensure immunizations are up-to-date (BCG usually given at birth unless symptomatic infant; other EPI vaccines as per schedule for HIV+ infants).

Monitoring & Follow-Up

• Requires lifelong, regular follow-up at ART clinic for monitoring (clinical, growth, CD4, viral load), adherence support, management of complications.

Counselling Points

• Explain the positive HIV result clearly and sensitively.
• Explain the critical importance of starting ART immediately for the baby's health.
• Explain the need for daily Co-trimoxazole.
• Provide detailed counselling on safe and appropriate infant feeding according to national guidelines for HIV-positive infants.
• Emphasize importance of adherence to both ART and co-trimoxazole.
• Counsel on preventing opportunistic infections.
• Address mother's health and ART adherence.
• Assess for TB and counsel on monitoring.
• Link family with support services.

Key Features

• HIV status of mother (and therefore infant exposure) is unknown.
• Requires urgent HIV testing and counselling (HTC) for the mother to guide infant management.

Classification

• HIV test not done for mother or infant -> HIV INFECTION STATUS UNKNOWN

Usimamizi

Non-Pharmacological Management

• Strongly encourage mother to go for HIV counselling and testing immediately.
• Provide general infant care advice.

Pharmacological Treatment

• Treat any current illness according to IMCI guidelines.
• Do NOT start Co-trimoxazole or infant ARV prophylaxis until mother's status is known.

Monitoring & Follow-Up

• Depends on mother accepting testing.
• If mother tests positive -> Manage infant as HIV Exposed.
• If mother tests negative -> Manage infant as HIV Infection Unlikely.
• Follow up for presenting illness.

Counselling Points

• Explain the importance of knowing mother's HIV status for the baby's health.
• Offer/facilitate immediate HIV testing and counselling for the mother.
• Explain confidentiality.

Key Features

• Requires TWO or more of the following signs: Lethargic/unconscious OR Movement only when stimulated/no movement OR Sunken eyes OR Skin pinch goes back very slowly (>2 seconds).
• Indicates severe fluid and electrolyte loss, which is particularly dangerous in young infants.
• Requires immediate fluid resuscitation, preferably IV or NG if trained (Plan C), and urgent referral.

Classification

• Two or more of the following signs: (Movement only when stimulated or no movement at all / Lethargic or unconscious) OR (Sunken eyes) OR (Skin pinch goes back very slowly) -> SEVERE DEHYDRATION

Usimamizi

Non-Pharmacological Management

• If providing Plan C in clinic: Ensure immediate access to IV/NG equipment and ORS. Monitor closely.
• If referring: Keep infant warm. Continue ORS sips frequently if possible.

Pharmacological Treatment

• TREAT WITH PLAN C (Young Infant Version - Page 41):
• If IV Therapy Possible Immediately: Start IV fluid. Give 100 ml/kg Ringer's Lactate Solution (or Normal Saline). Give 30ml/kg in 1 hour, THEN 70ml/kg in 5 hours.
• Reassess frequently (every hour initially). If hydration not improving, give IV drip faster.
• Also give ORS (about 5 ml/kg/hour) by mouth/NG tube as soon as infant can take it.
• Reassess dehydration status after 6 hours and choose appropriate plan (A, B, repeat C).
• If IV Therapy Not Available/Possible:
• If trained in NG tube insertion: Start rehydration by NG tube with ORS solution: give 20 ml/kg/hour for 6 hours (total 120 ml/kg). Reassess every 1-2 hours. If vomiting/distension, slow rate. If not improving after 3 hrs, refer urgently for IV.
• If NG tube not possible AND infant can drink: Refer URGENTLY. Give mother ORS and show how to give frequent sips during the trip.
• If infant also has another severe classification (e.g., PSBI): Refer URGENTLY after stabilizing airway/breathing and giving essential pre-referral treatments (e.g., antibiotic). Give frequent sips of ORS on the way if possible.

Monitoring & Follow-Up

• Managed initially under Plan C, then reassessed.
• If discharged on Plan A or B, follow-up as per those plans.

Counselling Points

• Explain the seriousness of dehydration in a young baby and the need for urgent hospital treatment.
• Show how to give ORS sips frequently during transport if applicable.
• Advise on keeping infant warm.
• Advise mother to continue breastfeeding whenever infant wants.