Children should be assessed for symptoms related to HIV and the need for treatment and prophylaxis for opportunistic infections and other HIV related conditions. Baseline laboratory tests should be performed to establish viral and immunological status whenever possible. A complete medical and immunization history should be obtained, with particular emphasis on the suspected mode of HIV transmission, history of ARV exposure (pre-, intra-, and post-partum, and during breastfeeding) timing of HIV diagnosis and family members who are aware of the diagnosis.
Children with HIV should receive routine paediatric care and should be monitored for their HIV disease status. Children under the age of 1 year should be seen monthly; thereafter, they should be seen every three months. At each visit a complete physical examination should be done paying particular attention to signs commonly associated with HIV infection (e.g., adenopathy, hepatomegaly, splenomegaly). Growth and development should be evaluated and charted at all stages of development through adolescence. The need for medication should be reviewed based on history, physical exam and laboratory findings. Doses of prophylactic or treatment medications should be adjusted for growth, and compliance and tolerability be assessed at every visit. Medication plans (OI prophylaxis and ARV therapy) need to be discussed intensively with parents or guardians. It is advisable that one single person in the household is identified as the consistent careprovider responsible for dispensing treatment to the child. HIV related care needs of parents or guardians themselves need to be discussed and referred appropriately.
Disclosure of HIV status to the child should be discussed with the parents or guardians. The process of disclosure can be done over time. Whenever the counsellor feels that the child starts asking questions about the disease and indicate to feel isolated or special due to the disease, close coordination with guardian/parent is crucial. Overall, one can start mentioning to a 4 - 6 years old child that they have a chronic disease which requires regular clinic visits and even medicines every day. At about 8 - 10 years it is recommended to start raising the issue of HIV/AIDS in a caring and supportive environment. Before the early teen years they should know they have HIV/AIDS, how it is spread and how to stay healthy. It has been shown that when properly counselled, children can cope adequately with this. It is particularly important that adolescents be informed of their status and so can become active participants in their own care.
Children exposed to ARV should be closely monitored at every visit for signs of toxicity (i.e., clinical or laboratory indications). Adverse events should be properly documented and reported to the Ministry of Health.