Pediatric HIV

PASADA PEDIATRIC UNIT

Pediatric unit at PASADA this is the special unit under the medical department which deals with children who are infected and affected with HIV.

The broad objective of this unit is to provide Comprehensive Care and Treatment to children living with HIV/AIDS in Dar es Salaam and Pwani regions.

The unit has 21 sites where pediatric care and treatment services are provided

The activities which are conducted in order to attain that broad objective are as follows:

• Enrollment of children  in care and treatment at PASADA and outreach sites, this is done by:

·    Testing HIV exposed infants from the RCH- PMTCT unit. (At the moment this is not a promising yield of HIV positive children because of the good interventions done through the Prevention of Mother To Child Transmission (PMTCT)).

·  Intensified Pediatric Case Finding (IPCF), Focused testing of children HIV: This is mainly done by the expert patient (people who are also living with HIV), they do work as volunteers to go to the community and Out Patient Department (OPD) to sensitize people for children HIV testing and also do visits to Orphanage centers. Their main focus is to look and locate those children who are not doing well health-wise, in order to minimize the over utilization of resources to where it is not needed much. We normally enroll 15-25 HIV children to PASADA and its outreach monthly, from this strategy. This is the most yielding method of bringing HIV Positive children to a hand of care and treatment at PASADA.

·   Through HIV Testing and Counseling(HTC): this is as the name suggests, is mainly for those children who are brought to HIV counseling and testing by their parents/caregivers.

·  Through provider initiated testing and counseling (PITC): This is another route through which children are enrolled into care and treatment. It normally happens by clinicians in the OPD and wards initiating the testing and counseling process rather than waiting for the parents and guardians to volunteer. It has shown some success in some areas as it has a very high yield.

· Morning talk sensitization: This is done through morning speeches and addressed to patient (adult ones) during their clinic visits while waiting for their services at PASADA clinics. We normally educate the parents/caregivers on the importance of early HIV testing to children and other issues associated with HIV, like drug adherence, disclosure and close follow up their children.

•       On the aspect of the improving the life quality of children living with HIV, the following activities are conducted at PASADA:

·       Putting more children on ART: This is very important aspect of combating and minimizing the consequences associated with HIV/AIDS.

-The goals for antiretroviral therapy for children are to: 

                 i. Prolong the survival of HIV-infected children 

                 ii. Promote optimal growth & development.

                                       iii. Preserve and enhance immune system and therefore reduce opportunistic infections. 

                 iv.  Suppress HIV replication and therefore prevent disease progression. 

                 v.  Reduce the morbidity of children and improve their quality of life.

·       User Friendly clinics for children and adolescent: 

     At our setting we have a very special mode of clinic attendance for children and adolescents, their clinics are normally conducted on Tuesdays based on their age range .This is very important because it makes the provision of health education during clinic easier according to the level of understanding, easier interactions amongst children themselves and health care workers. Through this mode of clinics it is simple to identify some children who are traumatized by their parents or caregivers or other people, this trauma may be verbal, physical and those with psychological problems. Because a child with a problem would be depressed, self isolating and less interactive. 

    During their clinics they are normally provide some tools for them to play with, things like bicycles, toys and balls.

-PASADA’s Pediatric HIV clinics are scheduled as follows:

i. 1^st Tuesday of the month: children aged 6 -11 yrs

ii.   2^nd Tuesday of the month: children aged 12-14 yrs

iii.  3^rd Tuesday of the month: 0 – 5 yrs

iv.  4^th Tuesday of the month: 15-24 yrs

  

· Availability of PASADA teen club for Adolescents living with HIV/AIDS:  

This is the platform of discussing issues pertaining adolescents, things like sexual and reproductive education. In order for them to be responsible for their health and may prevent sexually actively adolescents from unknowingly exposing others to HIV.

·     Psychotherapy Activities: 

 This is one of the very important non pharmacological management to children and adolescent who are infected and affected by the HIV. It comprises of art work like drawing, Ngoma (Traditional dances), and singing & Bereavement sessions. Through this activities children/ adolescent : 

                  i. Boost their self-esteems.

                  ii.  Discover their talents

                  iii. Discover their abilities, and know having HIV is not the end of the world they can do anything like anybody else. 

                  iv.  Recreate their minds.    

                  v. Get educated to cope with the challenges posed by the disease like stigma and discrimination and the issues of drug adherence.

 

Figure 1 : The art work done by one of the PASADA children portraying the importance of ARVs in his life.

(Note: From the picture, VVU- this is the Swahili abbreviation for Virusi Vya Ukimwi which means HIV)

·         Family Centered Care: This is the multidisciplinary approach of managing children living with HIV at PASADA; it involves all staff who are working at PASADA. In this approach children are a unifying factor. Through this service those vulnerable children from poor family are supported holistically, we do home visits when necessary. Sometimes we are forced to look and identify family tree of certain children who are orphans and abandoned. From this intervention a lot of children lives have been saved. This also is the platform of educating parents/care givers the importance of proper family attachment on managing children who are living with HIV/AIDS.

·         Specialist Consultation: This type of service is offered to those complicated medical cases, so we do collaborate with other higher referral health facilities

·         Provision of Nutritional Assistance: As the means of encouraging good drug adherence, PASADA do provide some small amount of food stuffs to children from very poor families, though the demand is much bigger than we can afford.

·         Linkage with other stake holders; this is the means of trying to look for other institutions which could offer some helps to children who are in need.

Figure 2: Some of the PASADA children enjoying their day at SERENA HOTEL

 

WELCOME TO PASADA & EXPERIENCE THE CHALLENGES AND SUCCESS EXPERIENCED BY THESE CHILDREN WHO ARE INFECTED AND AFFECTED BY HIV/AIDS!!!!!!!!!!!!

 

GRIEVING SESSIONS FOR CHILDREN LIVING WITH HIV

INTRODUCTION

PASADA takes care of more than 3000 children living with HIV. One of the challenges the children face is difficulty in understanding how they got the infection and coping with the losses of loved ones as a result of HIV and AIDS.

Having grieving sessions helps them in this process of building resilience. In its program, PASADA conducts Grieving Sessions to children every year.

Grieving is to mourn or feel sorrow for several reasons like death of our beloved ones, our sickness of our self or our beloved ones, separation, disasters, war etc. It is an approach of psychosocial support too.

Psychosocial support is the process of meeting a person's emotional, social, mental and spiritual needs. All of these are essential elements of positive human development.

Psychosocial support is needed by all children. It promotes their psychological and emotional well-being, as well as their physical and mental development.

Psychosocial support helps to build resiliency in children. It also supports families to provide for the physical, economic, educational, social and health needs of children. Children are resilient, but when faced with extreme adversity and trauma, they and their families can need extra support. Psychosocial support builds internal and external resources for children and their families to be able to understand and deal with adverse events.

Some children need specific, additional psychosocial support. These interventions usually target children who have experienced extreme trauma or adversity, or who are not receiving the necessary support from caregivers. Such interventions should be provided in addition to any ongoing support from families and community. 

Many things can impact on a child’s psychosocial well-being, including poverty, conflict, neglect and abuse. HIV and AIDS can compound these. As a result of HIV and AIDS, children might experience traumatic events such as the illness and death of parents or themselves, violence and exploitation, stigma and discrimination, isolation and loneliness, and lack of adult support and guidance.

Appropriate psychosocial support helps children and their families to overcome these challenges, and builds coping mechanisms, trust and hope in their future.

Advantages:

• Children know their potential in their family (as human beings)

• Accept the fact they live with HIV and they are affected with TB. When they take their TB medications properly will be cured and free from the disease.

• They forgive the people whom did not tell them their status.

• Promise to each other to study hard, and to achieve their goals.

• Children learn that in the community there are legal assistance systems like Police, Hospital and Schools that they are there to help them. Whenever they have problems can go and seek assistance.

Issues:

• Children living with HIV have needs which need to be discussed and understood.   
• Caregivers/parents/guardians need to be open to children especially on issues pertaining to their children.

• Caregivers need parenting seminars on dealing with co infected diseases.