Neobook — clinical reference

HIV Testing and Early Infant Diagnosis

3 - 6 Days	Follow-up results of birth HIV-PCR and manage accordingly. Any HIV positive neonate should be discussed/referred to a clinician experienced in managing an HIVpositive neonate. ART should be initiated even if the infants weighs less than 2,5 kg.
6 Weeks	Ensure that birth HIV-PCR and mother’s VL results were checked, recorded and acted upon correctly.
10 Weeks	Do HIV-PCR for all HIV-exposed infants who previously tested HIV-PCR negative.
6 Months	Known HIV-exposed infants: - Do HIV-PCR test at 6 months in all HIV exposed infants, except in those who previously tested positive and are on ART. Infants not known to be HIV-exposed: - At six months of age, establish the HIV status of all infants not already known to be HIV-exposed - Offer an HIV test to the mother. If she tests HIV negative, no infant test is required - If the mother is not available, or refuses an HIV test, get consent and do an HIV rapid test on the infant - All positive infant rapid tests need to be confirmed with an HIV-PCR.
18 months	Universal HIV testing at 18 months (HIV rapid test for all infants regardless of HIV exposure, except in those who previously tested HIV positive and are on ART)
Other tests (at any time)	Do an age appropriate HIV test 6 weeks post-cessation of breastfeeding, even if breastfeeding continues beyond 18 months of age. Test a symptomatic child at any age according to IMCI guideline.

The HIV-exposed but uninfected (HEU) child is at higher risk for poor outcomes and requires careful follow-up. Go to “Care of the HIV exposed but Uninfected Infant”

Use the NHLS Results for Action (RfA) Reports to follow up on laboratory results. Any child with a positive, indeterminate, or not-resulted PCR should be traced to come back to the clinic urgently. A clinical audit can provide insight into reasons for the failed VTP.

Confirmatory test for HIV

3-6 Days	Any child under two years with a positive HIV-PCR or a positive HIV rapid test should have their HIV status confirmed with an HIV-PCR test on a new sample. At the clinician’s discretion, the HIV-PCR may be replaced by a viral load test which has the advantage of both confirming the HIV diagnosis and providing a baseline VL for monitoring the child’s response to ART. Any child who tests HIV positive should initiate ART according to the Paediatric ART guideline as a matter of urgency. Do not wait for the confirmatory result before initiating ART but ensure that this result is checked. For the Management of Indeterminate HIV PCR results, go to “Management of Indeterminate PCR results and the Abandoned Infant”.
6 Weeks
10 Weeks
6 Months
AGE OF CHILD	HIV SCREENING TEST	HIV CONFIRMATORY TEST
Less than 18 months	PCR	PCR
18 months to 2 years	Rapid	PCR
More than 2 years	Rapid	Rapid

Infant Prophylaxis

3-6 Days	Check adherence/ tolerance to NVP (and AZT, if applicable). Ask the mother to explain how she administers the infant’s medication. Check result of mother’s delivery-VL. If necessary re-classify infant as higher / low-risk and adjust prophylaxis accordingly. See “Prophylaxis for the HIV-Exposed Infant at Birth”)	If mother diagnosed with HIV after delivery or during the breastfeeding period go to “Management of a High Maternal Viral Load after Delivery”
6 Weeks	Low-risk infant: Stop NVP if mother’s VL at delivery was < 50 c/mL. Higher-risk infants: - stop AZT, - continue NVP for a minimum of 12 weeks until maternal viral load suppression is obtained, or until four weeks after all breastfeeding has stopped.
10 Weeks	Higher-risk infants: Continue NVP prophylaxis. Review VL result if repeated at 6 weeks and stop/ extend NVP as necessary.	Stop NVP after 12 weeks only if mother’s VL is < 50 c/mL. If the maternal VL is not suppressed by 12 weeks, continued NVP until mother’s VL is <50 c/mL, or until four weeks after all breastfeeding has stopped. If a child tests HIV positive at any stage, stop NVP prophylaxis, initiate ART, do a confirmatory HIV PCR, and initiate cotrimoxazole prophylaxis according to guidelines.
6 Months	At every visit, check results of mother’s most recent VL. An elevated VL may require higher-risk infant prophylaxis (6 weeks AZT twice daily and 12 weeks NVP daily) to be restarted or existing NVP prophylaxis to be extended. Go to “Management of a High Maternal Viral Load after Delivery”.
18 Months
Other tests (at any time)

Remember to adjust NVP dosages according to weight

For any child who tests HIV-positive ensure that:
- Confirmatory testing has been done and the child is tracked and linked to care,
- The mother and other significant caregivers are counselled appropriately,
- CHWs are involved,
- The child is registered on Tier.net & retained in care.
- a nutritional assessment is done, and the breastfeeding mother is advised to continue breastfeeding her HIV positive baby

Other Routine Care

3-6 Days	Routine growth monitoring, immunisations, nutritional support. Provide advice to support breastfeeding. Go to “Breastfeeding Plus”.
6 Weeks
10 Weeks	Routine growth monitoring, immunisations, vit A, deworming and nutritional support. Provide advice to support breastfeeding. Go to “Breastfeeding Plus”
6 Months
18 Months
Other tests (at any time)

Click here for the pdf.

South African National Department of Health, Guideline for Vertical Transmission Prevention of Communicable Infections, Version 2_August 2023