Policy requirements for HIV testing and counseling of infants and young children in health facilities
Currently, many opportunities to diagnose HIV infection in infants and children are missed within the health system. These opportunities for diagnosis of HIV arise at facilities providing services for antenatal care, prevention of mother-to-child transmission (PMTCT) of HIV, immunization, nutrition, inpatient admissions and within programmes for other vulnerable children. It is estimated that only 8% of HIV-exposed infants received early virological testing in 2008. Analysis of international cohort data confirms that very few HIV-infected infants are started on antiretroviral therapy, and those who do receive it, are started when they are already very sick, largely due to a delay in HIV testing.
The benefits of expanded access to HIV testing and counselling for infants and children are numerous and include the following:
- early identification of HIV-infected infants and children as a first step to treatment and care;
- identification of HIV-exposed but uninfected infants, which facilitates follow-up care and prevention measures that will help to ensure that they remain uninfected and healthy;
- life-planning for parents and/or children who are HIV infected; and
- increased access to care and antiretroviral therapy for parents.
Providing HIV testing for infants and children, however, presents unique challenges for policy-makers, programme managers and health-care providers. To address these challenges, WHO and the United Nations Children’s Fund (UNICEF), in consultation with the Interagency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers and their Children, have prepared this policy brief, which is in line with existing WHO technical recommendations, including guidance on provider-initiated HIV testing and counselling issued by WHO in 2007. The brief aims to outline key issues that should be addressed within national policy guidance to support country programming. It is designed to be used by country programmes and technical working groups as they review and develop policy and practice guidelines relevant to HIV testing for children. For the purposes of this brief, infants and children should be considered to include all children who are 14 years of age or younger. Specific attention should be given to those issues related to children below the age of 10 years.