B18. NUTRITIONAL REHABILITATION UNIT (NRU) IS AN IMPORTANT ENTRY POINT FOR DIAGNOSIS AND TREATMENT OF HIV INFECTED CHILDREN
K Frederix, N Magongwa, R Lumala, M Fitzgerald, R Teck, MSF Luxembourg Thyolo District
Over 30.000 newborns acquire HIV/AIDS in Malawi annually. Half of them will die before the age of 2 years unless treated. In Thyolo district hospital until November 2004 only children over 18 months were routinely referred for VCT and thus considered for ARV treatment (ART), missing almost half of those in need. The objective of this study is to ascertain whether the nutritional rehabilitation unit (NRU) could serve as an entry-point to younger children in urgent need of ART at district level.
All children and their caretakers admitted at the NRU of Thyolo Hospital are offered VCT, regardless of age. Counselling on possible treatment, including ART and determination of CD4% for confirmation of HIV infection (for those under 18 months) and for decision-making on ART for all children is organised during admission or during further follow up.
From November 2004 – February 2005 a total number of 179 malnourished children were admitted to the NRU, of whom 53 (30%) were under 18 months. Of these 34 were sent for VCT and 17 (50%) tested positive. All children under 18 months who had CD4 carried out were below 20%, signifying severe immune suppression. Further follow up through the ARV clinic was organised for 14/17 of the infants. Seven children were put on ART.
Infants with severe immune suppression and in need of timely ART can be identified at the NRU. Furthermore CD4% does not seem necessary to confirm HIV infection or to assess ART eligibility in malnourished infants under 18 months at least those admitted to a hospital NRU. This needs further study.