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Introduction
Pediatrics is a word that represents the branch in medicine that specifically deals with the medical care of the young population from birth to 18 years of age who include infants, children, and adolescents. This area of specialty that developed in the mid-19th century mainly involves children physicians that provide medical care to chronically, or acutely ill children as well as providing preventive health services for already healthy children (Mandal, n.d). Within the developing countries, the number of children affected with HIV has risen drastically as a result of a vertical infection that mainly occurs either before birth, during delivery, or even after birth through the exchange of fluids between an infected mother and an infant (Rivera, 2020).
According to studies on the mortality rate of children from AIDS-related cases, the estimated number of children who died as a result of HIV was 100,000 while the total number of infected children in 2018 living with HIV was 1.7 million (WHO, 2020). According to WHO (2020), this notion could be attributed to the high number of children who were not under antiretroviral drugs (ARV) in 2018 whereby almost half of the children living with HIV were not under any ARVs program. Within contemporary society, failure to address the HIV virus at its early stages within children remains a big challenge, which is further aggravated by a lack of ARV formulations that are child-friendly. This research paper aims at identifying the potential risk factors for HIV/AIDS specialty care and also formulate an evidence-based practice for alleviating the potential risk of HIV to infants and children.
There is a need to develop evidence-based HIV/AIDS specialty care for children to mitigate the potential risks of the illness to children that should, however, be developed with the CDC recommended guidelines.
The population at Risks Factors
Albeit there has been some significant improvement in reducing the number of new infections among children from 2000, the population of children within the society living with HIV remain highly affected since they record the highest number of AIDs-related illness attributed to the infant mortality. Among the most affected population within the society by AIDS-related infections involves the young population aged 18 years and below. This notion is supported by research studies that indicate that most of the children aged 0-4 years are most likely to die than people of any other age living with HIV (Avert, 2020). Thus, most children are more vulnerable to the risk factors brought about by reduced immunity as opposed to older people who have a higher CD4 count that can provide immunity against external illness attracted by environments with reduced immunity. However, the populations are exposed to the risks also as a result of the lack of antiretroviral
Lack of effective testing programs
One of the most prevalent risk factors for children living with HIV is the lack of effective testing interventions among the communities with a high prevalence of HIV infections. While most healthcare policies require that women undergo a mandatory HIV-test during pregnancy, most of them are usually not provided with follow-up activities regarding HIV (UNICEF, 2009 pg.11). It is worth noting that early infant diagnosis of HIV forms one of the most significant steps in the implementation of programs like ART. Subsequently, studies indicate that there has been a positive outcome of therapies meant to decrease the risks of HIV infections, for example, increased prevalence of opportunistic infections as well as the reduction in the AIDS-related deaths among children (Davies, Gibb & Turkova, 2016). Thus, HIV infected children have found themselves living up to adulthood as a result of the exposure to a combination antiretroviral therapy (cART).
Antiretroviral treatment adherence
ART adherence is an issue that gains influence from a wide variety of factors including economic constraints, social stigmatization, difficulty in access, psychological factors, and late detection among patients (Basti et al., 2017). However, as much as there might be the availability of the ART programs, there is still a low turn up of patients seeking to their children to be enrolled in those particular programs mostly in Africa (Kelleman & Essajee, 2010). This provision could be a potential risk to children living with HIV since most of them only seek pediatric medical care when the situations for their children get worse and are symptomatic.
HIV disclosure
Despite an increase in the availability of testing through national policies and programs, developing countries still experience a considerably low number of children turning up to be tested with their parents or guardians. According to studies, fear of stigmatization from the family and the society, in general, is attributed to the negative health-seeking behaviors of parents, or guardians leading to delayed diagnosis and treatment (Merten, Ntalasha, & Musheke, 2016). This notion can also be understood from the family hierarchy aspect whereby in some of the societies in developing countries, access to medical care is limited to the decision by the head of the family. Hence, medical seeking interventions by the family members might be affected by the consent requirements from the father. This provision, coupled with the high level of social stigmatization inflicted among people living with HIV among these communities increases the risk among children already living with HIV.
Evidence-Based Practices
One of the most recommendable approaches to the treatment of HIV-Infected in Children involves the use of Antiretroviral Therapy. The use of highly active antiretroviral treatment (HAART) is associated with the long term reduction of mortality rates among children and adults as a result of AIDs-related illnesses (Patel et al., 2008). However, there still exist some undermining factors that limit the effectiveness of HAART interventions. This provision is based on the lack of an integrative approach towards pediatric medical care. Based on the above evidence, the most effective way of approaching HIV/AIDS healthcare involves the development of effective policies to ensure that all of the infants get tested and eventually get effective follow-up services after the diagnosis. This provision will facilitate the development of an effective treatment plan for women and their infants who have been exposed to the HIV virus by enrolling those particular individuals in their respective therapies based on their underlying conditions. It is worth noting that the lack of enough testing and monitoring of children is attributed to the low number of pediatric patients enrolled in the various specialized treatment programs for HIV (Iacob, Iacob & Jugulete, 2017). Thus, conducting the initial identification of Perinatal HIV exposure is important in developing an overview of the level of specialty required to attain quality health for the children.
According to the CDC, it is highly recommended that the HIV/AIDS Specialty Care for Pediatrics takes a collaborative approach during the treatments (Mofenson et al., 2009). A collaborative approach integrates the effort of both the pediatrics, the society, and the government in making the treatment interventions more effective. It is worth noting that one of the many barriers towards implementation of successful antiretroviral therapy (ART) involves the lack of sufficient support systems to make the seal any gap that may hinder the successful implementation of those programs for example social support through reduced stigmatization and the resource support from the government. According to studies, the main reason for defaulting from antiretrovirals (ARVs) was fear of openly disclosing the HIV status to avert the perceived stigma and discrimination from the general society (Chirambo et al., 2019). Thus, the prevalence of the risks brought about by the diseases normally brings about the high mortality rate among children due to reduced immunity from AIDS-related illnesses.
There should also be the development of education interventions whereby the family should be taken through intensive family training in the administration of the clinically prescribed medications. Through the education sessions, the family should be made aware of the importance of adherence to medication on the health of the child. Subsequently, this should be followed by frequent follow-up visits within the initial months after starting the regimen program to analyze the level of adherence to medication by the patients. The importance of education is exhibited across several studies that indicate the positive correlation between family education and the improvement in the level of the patient outcome as well as the increase in the level of enrollment of children into the ART programs.
Monitoring of HIV infection
Monitoring of the HIV infection to a large extent involves the analysis of the variation of the various elements within the body that are normally affected by the HIV infection. Examples of such elements include the CD4 count that analyzes the number of white blood cells within the body as a direct reflection of the immunity levels of children. However, the age variable should be considered when interpreting the CD4+ number within the children. Some of the age variables include the fact that the average count within the healthy infants is usually higher as opposed to CD4 count in those infected with HIV. This provision facilitates the development of an assessment of how prevalent the disease is within the children (Rice et al., 2019). The continuous clinical CD4 evaluation and analysis serves as an important feature within the contemporary pediatric medical care since it provides a more defined feature for HIV surveillance, which is usually included within differentiated care models. It is worth noting that HIV/AIDS Specialty Care for Pediatrics incorporates a wide range of children’s medical care based on the diversified range of opportunistic infections that arise as a result of a decrease in immunity among children. This measurement should be coupled with viral load monitoring which measures the number of HIV particles within the blood to get a differentiated outcome from the analysis.
Conclusion
According to the evidence provided above, the framework provided for the evidence-based practice (EBP) for HIV/AIDS Specialty Care for Pediatrics involves the development of a collaborative system or recording, monitoring, and treatment of the HIV/AIDS positive children. The framework involves interventions such as the development of a diagnosis of prenatal women and subsequently conducting frequent tests on the patients and their parents to determine their CD4 count. The CD4 count is generally used as the assessment criteria for the robustness level of the human system (Murrell, 2020). Thus, through the early identification of the HIV/AIDS positive patients, the CD4 count is maintained at the constant level or improved on by the various interventions for example ART that provides boosts to the immune systems within the infants and the adolescents. It is also worth noting that the intervention needs to be implemented within the most appropriate timeline to avoid the various risks brought about by reduced immune systems within the human body for example bacterial infections whereby they are more fatal to HIV positive than negative children.
References
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