In case of unavailability of the mother, the guardian needs to be counselled and the child started on co-trimoxazole prophylaxis. If PCR test is available, test the child at 6 weeks and proceed according to figure 5.2.
1. 6 weeks of age: HIV PCR 2. 3 months of age: Repeat HIV PCR to confirm 6 week result
1. A clinical examination to assess for signs and symptoms of HIV infection should be performed during all visits, and especially at 6 weeks and 3 months of age. The infant should thereafter be followed up as per recommendations for all children
2. Postnatal transmission of HIV infection is likely to be evident by 6 weeks after termination of breastfeeding. Nevertheless it is recommended that the final qualitative HIV PCR test on abandoned infants be performed 3 months after breastfeeding has ceased.
If PCR is unavailable clinical monitoring and prophylaxis should continue until the child reaches stage III upon which ART can be started. HIV testing (ELISA or rapid) should be performed as soon as the child attains 18 months of age.