This document summarizes primary level care for HIV-infected children in Kenya. It discusses care at the home and community level, including exclusive breastfeeding for 6 months, providing medications daily, clean water, growth monitoring, and immunizations. It also outlines the burden of HIV in Kenya, common opportunistic infections, risk factors for transmission, and the 4 prongs of eliminating mother-to-child transmission. The roles of caregivers, support groups, community health workers, NGOs, and IEC are described for supporting HIV-infected children.

1. PRESENTED BY ESTHER WAMBUI
MARGARET ADOYO
PRIMARY LEVEL CARE OF
HIV/AIDS INFECTED CHILDREN

2. Primary level care
● Primary level care refers to care that is provided at home, at
the community based at the dispensaries to the health
centres.
● Primary level care for children with HIV/AIDS involves
1. Exclusive breastfeeding for 6 months and optimal
complementary feeding.
2. Provision of the drugs by mother everyday
3. Provision of clean water
4. Growth and development monitoring
5. Psychosocial support
6. Immunization and routine de-worming

3. Burden of illness caused by HIV
● 1.6 million are living with HIV/AIDS in Kenya
● HIV prevalence in Kenya is 6%
● According to the Kenya HIV county profile (2016)
Kenya. It is estimated 6613 new infections occur
annually among the children
● In 2012 it was estimated children aged 18months -
14years prevalence rate was 0.9% approximately
100,00 children
● High HIV burden accounts for 15% of deaths among
children under 5

4. ● Common opportunistic infections are:
● Bacterial: Recurrent bacterial Pneumonia, Salmonella, Tuberculosis
● Fungal: Candidiasis, Cryptococcal meningitis, Pneumocystis jiroveci
pneumonia (PCP), Histoplasmosis
● Parasitic: Cryptosporidiosis
● Viral: Cytologmegalovirus, recurrent Varicella-zoster, recurrent herpes
infections (gingivostomatitis)
● Common AIDS-related cancers in children include Kaposi sarcoma and
Lymphoma.
● HIV-infected children are more prone to getting these infections due to
their low immunity status compared to children without HIV.
● Severity of disease in HIV-infected children is greater than in children
without HIV

5. RISK FACTORS
● VERTICAL TRANSMISSION( 90% of pediatric cases)
○ Vaginal delivery with elevated maternal viral load and invasive
procedures during delivery
○ Rupture of amniotic fluid more than 4 hours before delivery
○ Preterm delivery <34 weeks
○ Breastfeeding risk of transmission 5-20% however with ARVS
risk of transmission <1%
○ Mixed feeding
○ Breast disease(cracked nipples,mastitis)

6. ● Transfusion of infected blood and blood products
● Sexual transmission
i. Sexual contact especially among the adolescents
ii. Sexual abuse

7. 4 Prongs of Elimination of Mother To Child Transmission of HIV
(EMTCT)
● The four pillars that are key in promoting HIV-free survival of
children include:
1. Primary prevention of HIV in women especially young
women.
● This can be achieved through the ABC strategy;
● Abstain from sex until marriage,
● Be faithful to one partner,
● Consistent and correct condom use .
● Treating sexually transmitted infections and pre-exposure
prophylaxis
● Parents and caregivers to educate their children how HIV is
transmitted and prevention methods, and modeling appropriate
behavior for them.

8. . Preventing unintended pregnancies in HIV-
infected women.
● This can be achieved through:
1. Integrating counselling and testing in family
planning services
2. Use of effective family planning methods
3. Avoid risky sexual behaviors

9. . Prevention of vertical transmission from HIV
infected mother to child to reduce infection during
pregnancy and lactation
● Interventions that can prevent transmission include:
1. Routine HIV testing during ANC visit and before delivery
2. Immediate initiation of ARVs upon diagnosis of HIV
during pregnancy and counseling on importance of
adherence to keep viral load low.
3. Provision of effective antiretroviral treatment and
prophylaxis to sero exposed child
4. Ensuring there is compliance to treatment
5. Exclusive breastfeeding in the first 6 months

10. Promotion of the survival of the mother and other family members.
For the mother:
● Provision of ART, prevention and treatment of opportunistic infections
● Psychosocial and nutritional support
● Family planning
For the child:
● Provision of ART, Cotrimoxazole prophylaxis
● Adequate nutrition
● Immunization and routine deworming
● Growth and development monitoring
● Provision of multivitamin and micro nutrient supplementation
For other family members:
● HIV testing, prophylaxis against opportunistic infections and ART treatment

11. IEC
● IEC(information education and communication)
● This a group of activities and outputs mostly media and
interpersonal communication that help those in population at
risk for a certain health event evaluate their own behavior and
develop new behaviors to prevent new infections
● With regards to HIV, this helps in creating awareness on the risks
of acquiring infection and how to stay negative if HIV negative
and if positive how to live a healthy life and prevent transmission
of infections to others.
● When incorporated into children's entertainment programmes
and schools, using age appropriate language and examples can
serve as an important means to educate children and adolescents
on HIV/AIDS.

12. CONTROL OF HIV/AIDS
● Role of IEC(Information Education&
communication)
1. Public education and interventions (through
appropriate mass media and interpersonal channels
especially high risk groups)
2. Advocacy - makes aware of the magnitude of the
impact of HIV/AIDS to policy makers and
influences adoption of policies that will limit spread
of HIV and stigma/discrimination of PLWHIV.
3. Supports various components of an AIDS
prevention and control programs.

13. Disclosure
Beneifts of disclosure from the health provider to the
child include
● Ease to access to ART
● Social support from the family and community
● Ease to access to HIV related services such as counselling
and participating in education and training services
● The child understands his/her status early and promotes
compliance to medication especially among the youths

14. STIGMA AND DISCRIMINATION
● Stigma- is a feeling of disapproval associated with a particular
circumstance,
● Discrimination-is unfairly treating a person differently from another
person
● It prevents infected persons from seeking HIV counseling, testing, care
and treatment and hinders acceptance of an infected person from the
community
● It can be prevented by:
○ educating communities
○ setting national guidelines on care of HIV infected persons
○ reassurance
○ fostering self awareness among infected persons
● Therefore, increasing self awareness, reassurance and setting national
guidelines on provision of HIV services may aid in reducing and even
avoiding stigmatization

15. Care and treatment at home and community
○ At home
● Provision of healthy and balanced diet to children
● Provision of emotional support by caregivers and family
● Practice good hygiene at home to prevent infections I
● Ensure compliance by giving medication to children
○ Community
● Provide social support
● Promote adherence to medication
● Raise awareness disseminate information and reduce stigma
through education

16. ROLE OF CAREGIVERS AND SUPPORT GROUPS
● Create awareness on the HIV status
● Administration of ARVs and prophylactics to the
children/infants
● Ensure adherence and compliance to the medications
● Provide adequate nutrition
● Monitoring of any complications that may arise e.g. from
the drugs,
● Monitoring for any opportunistic infections
● Psychosocial support
● Forming support groups, and encouraging them to take part
in development projects, games or other recreational
activities

17. Role of community health workers
● Identify children/families that need special care e.g.
those with disability rape survivors orphans
● Provide guidance and counseling to affected families
● Act as trained birth attendants to HIV positive
women who cannot access health centers
● Educating community about HIV/AIDS

18. ROLE OF NGOS AND FBOS
● Mobilizing resources and ensuring accountability in
utilization of resources
● Advocacy and creating public awareness about HIV/AIDS
through outreach programs and the World International
AIDS Day held on the 1st of December
● Fighting against stigma and discrimination associated with
HIV/AIDS
● Collaborating with both government and other NGOs to
take part in the fight against the HIV pandemic
● Providing support to orphans and other vulnerable children
within communities

19. references
● Kenya HIV County Profiles 2016
● Lancet studies 2015
● Nelsons paediatric text book
● Guideline for PMTCT Kenya 2012
● Kenya AIDS Indicator 2012