HIV is increasingly affecting the health and welfare of children and undermining hard-won gains in child survival in some of the highly affected countries. Recent estimates from UNAIDS suggest that, globally, about 2.1 million children younger than 15 years of age have HIV. The roll out of paediatric HIV care and treatment is faced with three challenges: lack of appropriate paediatric ARV formulations, delayed infant HIV diagnosis, and lack of skills of health professionals to manage cases. The manual is expected to address the third challenge. It is an addendum to the “Pocket book of Hospital Care for Children,” as well as to IMAI and IMCI guidelines. WHO initiated the collaborative development of this manual because existing guidelines, including the “Pocket Book of Hospital care of Children,” were found inadequate to provide specific guidance for the complex management of paediatric HIV at district hospitals.
The Department of Child and Adolescent Health and Development, in collaboration with the HIV/AIDS department, planned the development of several second-level or referral level manuals, including the paediatric addendum, during 2006. The materials are targeted at doctors, but can be used by clinical officers or experienced nurse clinicians in some settings. The paediatric manual is designed to guide management on paediatric ART and opportunistic infections. It is not designed to teach tertiary level care, but to support care in the health centres and beyond.
The first technical consultation took place from February 27-March 3, 2006 where experts of different organizations contributed to the initial outline of the manual. The participants were selected from different regions of the world and represented important players in the area of paediatric HIV. The experts used existing WHO guidelines, other published and unpublished materials, and their own professional experiences to shape the manual.
The following steps were taken mostly on consensus regarding manual contents:
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Agree on a minimum competency list for second-level care and primary-level care
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Agree from which existing policies and guidelines the content will come
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Distribute tasks to small groups to draft the first chapters
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Circulate first draft among meeting participants for comments, and develop second draft accordingly.
A second technical consultation was organized from 17-19 October, 2006, using the same experts to review the draft chapters and further refine them. This consultation's primary objective was to simplify the manual and make it reader-friendly without compromising quality.
Furthermore, recommendations from the following 2010 WHO guidelines were recently incorporated:
Antiretroviral therapy for HIV infection in infants and children: Towards universal access. Recommendations for a public health approach: 2010 revision.
WHO recommendations on the diagnosis of HIV infection in infants and children. 2010 revision.
Guidelines for intensified tuberculosis case finding and isoniazid preventive therapy for people living with HIV in resource constrained settings. 2011.
Guidelines on HIV and infant feeding 2010. Principles and recommendations for infant feeding in the context of HIV and a summary of evidence.
WHO recommendations on management of pneumonia and diarrhoea in HIV-infected infants and children. 2010.
