SOLWEZI SCHOOL OF NURSING

LESSON PLAN
COURSE: PEDIATRICS
TOPIC: HIV AND AIDS IN CHILDREN
DATE: 24th FEBREURY
TIME: 14 HOURS
TARGET: 2ND YEAR STUDENTS
DURATION: 2 HOURS
PRESENTER: FWALANGA KAZAU
SUPERVISOR: MS. NACHAMBA
VENUE: LECTURE THEATER
AUDIO VISUAL AID: ROJECTOR, WHITE BOARD, BLACK BOARD, MARKER
AND CHALK
TEACHING METHOD: LECTURING / DISCUSSIONS

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GENERAL OBJECTIVE

At the end of the lesson Students should be able to acquire knowledge and demonstrate an understanding of HIV and AIDS in
children.

SPECIFIC OBJECTIVES

At the end of the lesson students should be able to:

1. Definition of terms
2. State the mode of transmission of HIV to children.
3. Explain the diagnosis of HIV in children.
4. Identify children in need of DBS.
5. Outline the collection of DBS samples.
6. State the WHO staging of HIV in children.
7. Outline the clinical course of HIV infection in children.

INTRODUCTION
Good morning class, am Fwalanga Kazau a student tutor from LUSAKA APEX MEDICAL UNIVERSITY. Today will be discussing
HIV and AIDS in children. Human immunodeficiency virus (HIV) is the virus that is responsible for causing acquired immune
deficiency syndrome (AIDS). The virus impairs cells of the immune system and progressively destroys the ability of the body to fight
the infection in adults and adolescents.

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDENT EVAL
ALLOCATED OBJECTIVES VISUAL ACTIVITY ACTVITY
AIDS
10 minutes Definition of Definitions Projector Explaining, Listening, What
terms - AIDS- Acquired Immunodeficiency syndrome (WHO) , White asking answering two d
betwee
- HIV- Human Immunodeficiency Virus (WHO) Board, questions, questions,
and AID
- Immunodeficiency- is a state in which the immune Black answering asking
system’s ability to fight infectious disease is compromised Board questions questions,
or entirely absent. (WHO) Marker. taking
- Viral load- A measure of the number of viral particles Chalk. notes
present in an organism or environment, especially the
number of HIV viruses in the bloodstream. (WHO)
- CD4 count- is the test that measures how many CD4 cells
you have in your blood. These are a type of white blood
cell, called T-cells, that move throughout your body to
find and destroy bacteria, viruses, and other invading
germs. (WHO)
- Drug resistance-is the reduction in effectiveness of a
medication such as an antimicrobial or an antineoplastic in
curing a disease or condition. (WHO)

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDENT EVALUATION
ALLOCATED OBJECTIVES VISUAL ACTIVITY ACTVITY
AIDS
5 minutes State the mode Mode of transmission of HIV to children Projector, Explaining, Listening, What are the 4
of transmission - Most children get the virus from their infected mother White asking answering mode of
transmission of
of HIV to during delivery when exposed to infectious blood and Board, questions, questions,
HIV to children
children body fluids Marker. answering asking that you know?
- Through breastfeeding especially when the mother has Chalk. questions questions,
cracked nipples and the baby has oral thrush taking
- During pregnancy the fetus can get infected by HIV notes
crossing the placenta
- Blood transfusion
- Organ transplant
- Sexual intercourse.
15 minutes Explain the Diagnosis of HIV in children Projector, Explaining, Listening, How is HIV
diagnosis of children (0 to <10 years old) White asking answering diagnosed in
HIV in children.  Well, never-breastfed HIV Exposed Infant (HEI) Board, questions, questions, children ?
- At birth/first week of life or at first contact a nucleic Marker. answering asking
acid test (NAT) is done which is repeated at 6 weeks Chalk. questions questions,
old, taking
- At 18 months old a Serologic test is done notes

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDENT EVALUATION
ALLOCATED OBJECTIVES VISUAL ACTIVITY ACTVITY
AIDS
15 minutes Explain the Projector Explaining, Listening, How is HIV
diagnosis of  Well, breastfed HEI , White asking answering diagnosed in
- At birth/first week of life or at first contact nucleic acid
HIV in children Board, questions, questions, children ?
test (NAT) is done which is repeated when the child is 6
weeks old and at 6 months old. Marker. answering asking
- At 9 months old a Serologic test is done. If the child is Chalk. questions questions,
found to be positive, follow with NAT. If negative,
taking
follow up with serologic test at 18 months
- At 12 months old Serologic test, if positive, follow with notes
NAT. If negative, follow up with serologic test at 18
months
- 18 months old Serologic test; if positive, follow up with
NAT
- 24 months old Serologic test, if positive, follow up with
NAT
 Infant or child who has completely stopped
breastfeeding
- ≥6 weeks after breastfeeding cessation
Serologic test should be done; if positive, follow up
with NAT
- ≥18 months old Serologic test

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDENT EVALUATION
ALLOCATED OBJECTIVES VISUAL ACTIVITY ACTVITY
AIDS
15 minutes Explain the Diagnosis of HIV in children Projector Explaining, Listening, How is HIV
diagnosis of  Asymptomatic infant with unknown HIV exposure , White asking answering diagnosed in
children ?
HIV in children - At first contact, a Maternal serologic test and infant Board, questions, questions,
serologic testis done which is followed by performing a Marker. answering asking
NAT for positive serologic child <18 months old. Chalk. questions questions,
 Infant or child symptomatic for HIV infection taking
- Immediately regardless of age Serologic test; follow notes
with NAT for positive serologic
 Positive serologic child <18 months old
- At first contact NAT
- For all infants and children with unknown HIV status
admitted for inpatient care, attending malnutrition clinic,
outpatient care or immunization clinics, an Age-
appropriate Routine HIV tests is done.
 Adolescents (10 – 19 years) and adults
- All sexually active persons with their partners and any
person of unknown HIV status
- At first contact, 3 months if negative and every 6 months
- Serologic test is performed.

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDENT EVALUATION
ALLOCATED OBJECTIVES VISUAL ACTIVITY ACTVITY
AIDS
15 minutes The diagnosis Diagnosis of HIV in children Projector Explaining, Listening, How is HIV
of HIV in - Note: Where there is no POC NAT a DBS should be , White asking answering diagnosed in
children ?
children sent for HIV PCR. Where NAT is positive, a repeat test Board, questions, questions,
should be done to rule out false-positive results. cART Marker. answering asking
should be initiated without waiting for the receipt of the Chalk. questions questions,
second test result because of the high risk of mortality taking
with in utero infection; if the second specimen tests notes
negative, a third NAT should be performed before
interrupting cART. Although plasma remains the gold
standard sample for NAT, DBS will be the preferred
mode of sample transportation for both DNA and RNA
testing.
10 minutes Identify Identifying children in need of DBS (Dried Blood Spot) Projector Explaining, Listening, How can you
children in need  Two types of infants who will need HIV diagnostic , White asking answering identify a child
in need of a
of DBS. testing Board, questions, questions,
DBS?
 Infants who are HIV- exposed (mother known HIV Marker. answering asking
positive from ICTC) Chalk. questions questions,
 Infants who are sick with signs and symptoms of HIV, taking
even if unknown HIV exposure status. notes

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDENT EVALUATION
ALLOCATED OBJECTIVES VISUAL ACTIVITY ACTVITY
AIDS
10 minutes Outline the Collection of DBS samples Projector Explaining, Listening, How is DBS
collection of DBS Collection Procedure , White asking answering sample
DBS samples  Choosing the location to draw blood is important in Board, questions, questions, collected?
preparing a DBS sample. If the area does not bleed Marker. answering asking
sufficiently, the sample may be too small to test. Chalk. questions questions,
- For children 1-4 months old and weighing less than 6 kg, taking
collect from the Heel notes
- 5-10 months, less than 10 kg Toe
- Larger than 10 kg Finger
- After choosing the location, proceed to Warm the
baby’s foot or hand, if older than 10 months or larger
than 10 kilograms to facilitate blood flow. This can be
done by wrapping a hand around the foot while the baby
sits in its mother’s lap.
- Then Position the baby with its feet down.
- Clean the baby’s foot with disinfectant and let it dry.
- While wearing gloves free of powder, then pricks the
baby’s foot with a lancet to draw blood.
- The first drop of blood should be wiped away with gauze
or cotton wool.

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDENT EVALUA
ALLOCATE OBJECTIVES VISUAL ACTIVITY ACTVITY
D AIDS
10 minutes Outline the Collection of DBS samples Projector Explaining, Listening, How is
collection of - Then allow a large drop of blood to collect on the foot , White asking answering sample
DBS samples before touching it to the circle on the filter paper. The Board, questions, questions, collected
circle should be filled completely by the blood drop Marker. answering asking
and at least two circles should be filled per card. Chalk. questions questions,
- The foot should then be cleaned with disinfectant and taking notes
left unbandaged.
10 minutes State the WHO Clinical Staging of Pediatrics HIV Infection Projector Explaining, Listening, What are
staging of HIV  WHO clinically classifies children into four stages (1, , White asking answering stages of
in children. 2, 3 and 4) representing progressively more severe Board, questions, questions, children?
disease and worsening prognosis. Marker. answering asking
- Stage 1is the asymptomatic stage Chalk. questions questions,
- Stage 2 is the mild stage the child presents with taking notes
symptoms like Fungal nail infections, Recurrent oral
ulcerations, Lineal gingival erythema, Angular
cheilitis, Parotid enlargement, Herpes zoster etc.
- Stage 3 is the advanced stage characterized by
Moderate unexplained malnutrition, not adequately
responding to standard therapy Unexplained persistent
diarrhoea (14 days or more).

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDEN EVALUA
ALLOCATE OBJECTIVES VISUAL ACTIVITY T
D AIDS ACTVITY
10 minutes The WHO WHO staging of HIV in children. Projector Explaining, Listening, What are
staging of HIV  Stage 4 is the severe stage there during this stage, there , White asking answering stages of
children?
in children. are many complications that develop such as; Board, questions, questions,
unexplained severe wasting or malnutrition not Marker. answering asking
responding to standard therapy, Pneumocystis Chalk. questions questions,
pneumonia, Recurrent severe bacterial infections taking
(empyema, pyomyositis, bone or joint infections, notes
meningitis)
10 minutes Outline the Clinical course of HIV infection in children Projector Explaining, Listening, What is t
clinical course  Category 1 (25 – 30%): Rapid progression , White asking answering clinical c
of HIV
of HIV Rapid disease progression; infants die within 1 year. Board, questions, questions,
infection
infection in Disease acquired in-utero or perinatally. Marker. answering asking children
children  Category 2 (50 – 60%): Slow progression Chalk. questions questions,
Children who develop symptoms early in life. taking
Deteriorate and die by 3 to 5 years. notes

 Category 3 (5 – 25%): Long-term survivors

Long-term survivors who live beyond 8 years of age.

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDEN EVALUA
ALLOCATE OBJECTIVES VISUAL ACTIVITY T
D AIDS ACTVITY
10 minutes Outline the Clinical course of HIV infection in children Projector Explaining, Listening, What is th
clinical course  There are some factors that are related to disease , White asking answering clinical co
of HIV progression and these are: Board, questions, questions, of HIV
infection in - Size of infecting viral dose which is dependent on Marker. answering asking infection
children maternal disease status. Chalk. questions questions, children
- The child’s immature immune system limits ability to taking
contain the virus. notes
- Low infant CD4+ cell counts/percentages. Infants with
high peak viral load have more rapid progression.

Clinical presentation of rapid progressors

Early Severe Form is characterized by the following:
 LBW,
 Early stunting,
 Developmental delay,
 Persistent oral candidacies,
 Recurrent/persistent diarrhoea,
 Recurrent bacterial/fungal infections,
Hepatosplenomegaly,

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TIME SPECIFIC CONTENT AUDIO TEACHER STUDEN EVALUA
ALLOCATE OBJECTIVES VISUAL ACTIVITY T
D AIDS ACTVITY
10 minutes Outline the Clinical course of HIV infection in children Projector Explaining, Listening, What is th
clinical course  Clinical presentation of slow progressors , White asking answering clinical co
of HIV - Opportunistic Infections after 2 - 10 years Board, questions, questions, of HIV
infection in - Growth stunting common Marker. answering asking infection
children - Lymphoid interstitial pneumonitis (LIP) Chalk. questions questions, children
- Parotitis taking
- Recurrent bacterial and fungal infections notes
- Skin problems
- AIDS related cancers
- Low viral loads at birth, stable CD4 counts for 2 - 10
years then slow decline

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EVALUATION

1. What are the modes of transmission of HIV to children?

2. How is HIV diagnosed in children?
3. How is DBS samples collected?
4. What are the stages of HIV in children?
5. What is the clinical course of HIV infection in children?

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References

Dr. K.P. Tshering, and Dr. Mimi Lhamo. (2008). Guideline for Management of Pediatric HIV/AIDS. Custom Design & Printing
Souvenir. Thimphu, Bhutan

Lipson M. (1994). Disclosure of diagnosis to children with human immunodeficiency virus or acquired immune deficiency syndrome.
J Dev Behav Pediatr.

World Health Organization. (2014). GUIDELINES ON POST-EXPOSURE PROPHYLAXIS FOR HIV AND THE USE OF CO-
TRIMOXAZOLE PROPHYLAXIS FOR HIV-RELATED INFECTIONS AMONG ADULTS, ADOLESCENTS AND CHILDREN:
RECOMMENDATIONS FOR A PUBLIC HEALTH APPROACH. Geneva 27, Switzerland

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