Capstone Session: Integrating Child Counselling in

Adult ART Clinics

Capstone Session: Integrating Child Counselling in

Adult ART Clinics

By the end of this session, trainees should be able to:• Explain the key entry points to HIV care for children and

adolescents

• Identify the Essential Elements for the continuum of care for children

Integrating Paediatric Care

• To be effective, paediatric care and treatment interventions need to become an integral part of infant and child survival and health programmes.

• Family centred care model should be promoted.

Essential Elements for the Continuum of Care for Children

• Mechanism of identifying HIV infected and exposed infants

• Effective referral system• Defined care package• Functional care team• Staff supportive services• Logistics management systems• Health management information systems

Mechanism of Identifying HIV Infected and Exposed Infants

Ensure all entry points are identifying and testing children– Train them– Provide test kits and all

materials– Provide registers

• Entry points– Paediatric ward– ANC– Maternity– Youth Centre– Therapeutic Feeding– Outpatient Dept– Community– Adult wards

Organize “Know Your Child’s Status” Day (KYCSD) Campaigns

• Campaign aimed at testing children• Set a date and venue for the activity• Prepare logistics: test kits, personnel• Conduct mobilization during clinic days• Conduct the activity and refer all exposed and

infected children for care

Establish an Effective Referral System

• Intra-facility (inter-departmental) referrals – Youth Care Clinic to ART clinic– Antenatal Care to ART clinic– ART clinic to laboratory– ART clinic to wards

• Inter-facility referrals• Community to facility referrals

Referral must be written NOT word of mouth

A Defined Care Package- 10 Point Care Plan

• Early infant diagnosis• Cotrimoxazole prophylaxis

for OI prevention• Growth and development

monitoring• Immunization, nutritional

support, including multivitamins and iron

• Routine quarterly deworming with Mebendazole

• Aggressive management of acute illnesses

• Psychosocial support and palliative care

• Adolescent care and support

• Family-focused care including PMTCT

• ART when indicated and available

A Functional Care TEAM with a Strategic Direction and a Leader

Staff Supportive Services

• Capacity Building– Formal/didactic Training– CME

• Multi-disciplinary team meetings• Management-support• Support supervision/mentorship frame work• Exchange programmes/attachments• Prevention and management of staff burn-out

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Logistics Management Systems

• Must have stock cards• ARV bi-monthly report and order forms• ARV dispensing logs• Good storage facilities for the drugs

Health Management Information Systems

What tools are recommended for data collection and reporting?

Data collection tools• EID register• Pre ART register• ART register• ART dispensing log

Reporting tools• Quarterly ART report

books• Bimonthly Logistics

report

Family Centred Care Approach Should Be Encouraged

• HIV infected children and their parents should be cared for in the same clinic.

• Paediatric HIV and AIDS care and treatment services should therefore be integrated into existing adult ART care services.

Parallel care clinics for children should therefore not be initiated at sites that already

have adult care clinics.

Integration of Paediatric Services into Adult HIV Clinics

Involves: • Creation of a ‘child-friendly’ clinic environment

– play materials, elementary pictorial books and arts/craft materials

• Ensure availability of child friendly drug formulations (ARVs and OI drugs)

• Re-align appointment with adult caregiver seen in the same clinic

Integration of Paediatric Services into Adult HIV Clinics

Involves: • Introduce family-focused approach

– Build capacity among staff to care for the children– Active identification of children of the same

household– Focus on pregnant women

• Introduce capacity for routine infant diagnosis• Continuous mentoring by experienced clinicians

Challenges of Integrating Paediatric HIV Care into Adult HIV Clinic

• Lack of personnel trained in paediatric care• Resistance among adult staff to deal with

children• Poor paediatric and adolescent approach• Lack of ‘child-friendly environment’• Risk of indirect and inadequate disclosure• Weak referral system between paediatric

services and adult HIV clinic

REVIEW

Why is it important to have an effective referral system for all departments in the clinic?

What are the key points included in the 10 point management plan for HIV+ children?

What are 3 strategies for integrating paediatric services into adult ART clinics?

Integrating Paediatric Care into Adult ART Clinics

Integrating Paediatric Care into Adult ART Clinics

1. In your team (per facility), think about three specific actions to integrate paediatric HIV counseling in the existing adult clinics

2. When you are ready ask the facilitator to give you a pledge of action form

3. The actions must be completed within the next 3 months

Self-Assessment

• Drafting a Skills Development Plan• Think about the 4 counselling events:

1. Feeding and HIV Testing for the Exposed Infant2. HIV Testing and Counselling3. Counselling to Prepare for the Start of ART and

Supporting Adherence4. Living with HIV (including Crisis Intervention)

• For each type, identify 2-3 skills to work on• Create an action plan for how you will do it

We’ve Reached the End of the Course…

We’ve Reached the End of the Course…

But not the end of learning!

Where We’ve Been

• Introduction: Course Goal, Objectives and Overview

• Module I: Essential Background Paed HIV Counselling

• Module II: Feeding and HIV Testing for Exposed Infants

• Module III: HIV Counselling and Testing

• Module IV: Preparing to Start of ARVs and Supporting Adherence

• Module V: Living with HIV (including Crisis Intervention)

• Capstone: Putting it all together

Course Objectives

By the end of this 5-day course, trainees should be able to:• Explain the importance of EARLY infant diagnosis and

treatment in order to reduce infant mortality.• Identify the role of effective counselling as part of a

comprehensive approach to the care and treatment of HIV infected infants, children, and adolescents.

• Appropriately use MoH Tools and Guides (Job Aids) to counsel HIV-exposed or infected children, adolescents and their caretakers.

Course Objectives (2)

By the end of this 5-day course, trainees should be able to:• Demonstrate confidence, knowledge and skills to

communicate with and counsel HIV-exposed or infected children, adolescents and their caregivers.

• Effectively address disclosure, positive living, and stigma and discrimination as key parts of the process for every counselling event.

• Recommend specific actions to improve HIV clinic systems that will result in more effective provision of paediatric HIV counselling services.

Job Aids for 5As

Paediatric HIV Counselling Flipchart – (all) HIV testing, ARVs, Positive Living

Lukia’s Story – (kids 5-10) stigma, disclosure, adherence

“Thinking About Sex?” Adolescent Booklet (kids 10-18) SRH prevention with positives

Caregiver Booklet – all topics

By the bottom of each page of the Paediatric HIV Counselling Flipchart , you will be prompted to work with your client toward an agreed next steps.

Infant feeding Algorithm – infant feeding risk reduction

Paediatric HIV Counselling Flipchart – infant feeding, disclosure, adherence, abstinence, SRH

Lukia’s Story – disclosure & adherence)

Thinking About Sex?” Adolescent Booklet – SRH prevention with positives

Caregiver Booklet – all topics

Exposed Infants Care GuidelinesTesting Algorithm for HIV Exposed Infants

Child Health Card (2011)

Paediatric HIV Counselling Flipchart – profiling pages

CounsellingHCT Card

ART adherence card

ASSESS ADVISE AGREE ASSIST ARRANGE

Thank You