Growing Up commissioned a quality survey to assess the degree of satisfaction and use of its information and educational materials (Growing Up Info, fact sheets, toolkits) for those working in prevention and comprehensive care of pediatric HIV in Africa. The survey was also used to evaluate the effect of the October 2007 training seminar in Abidjan, « Infants born to HIV+ mothers and Nutrition » on participants’ knowledge and practices.
The survey was conducted from May to June 2009 among the program’s partner organizations.
The analysis of results suggests that training has a very positive impact on participants’ knowledge and practices. They have acquired knowledge that they use in their professional practices. The survey shows that the educational materials are not used to their full potential: this can be explained by a lack of computer or Internet access, printing costs, and lack of time. We can also assume that not everyone has succeeded in adapting these materials to what they do. This is particularly true for recent GROWING UP partners in Central Africa who have only received support since early 2009.
GROWING UP’s liaison in each organization, psychologists and doctors use the educational materials more than those working in a paramedical or social service context.
Community feedback concerning the content of the materials is very positive and users are satisfied by their quality. This survey will help us to develop our future strategies and adjustments so as to strengthen GROWING UP’s capacity to further improve care and support of HIV affected and infected children and their families.
The GROWING UP staff would like to encourage and thank those community members who, in participating in this study are contributing to the overall design and improvement of the program.

Two articles published in June 2009 sum up studies underway in the Zambia and South Africa on routinely testing children for HIV.
The first study conducted in Lusaka, Zambia, demonstrates the results of testing children during the course of their hospital stay: out of 15,670 children
of unknown HIV status admitted over a period of a year and a half,13,239 (85%) parents/guardians received counseling and 11,571 children were tested for HIV. Three thousand three hundred and seventy-three (3,373=29%) of these children diagnosed HIV positive. Sixty-nine percent of these children were under 18 months. HIV prevalence was significantly higher in children admitted for malnutrition or who suffered from diarrhea/dehydration (36% in children suffering from malnutrition).
The second study conducted in South Africa concerned the acceptability of testing during visits to the doctor for vaccinations. Six hundred forty-six mothers –1/3 of who knew they were HIV positive – were offered an HIV test for their children (average age < 8 weeks). Out of this number 584 mothers (90%) allowed their children to be tested for HIV. Two hundred forty-seven children tested positive (42%). Among the women who claimed to be HIV negative, 7% of their children tested positive.
Seventy-eight percent of the women stated they were not uncomfortable with this type of routine testing.
Routinely testing children who have come to be vaccinated makes it possible to direct parents and infants who test positive to care and ARV programs. In high HIV prevalence countries this policy makes it possible to test over half of the newborns early (between 6 and 10 weeks).
Additionally, testing children during a hospital stay means that a considerably larger number of children are diagnosed. This facilitates children and parents to have access to healthcare and treatment if they are infected by HIV.
The results of these two studies demonstrate that all contact with the health care system can been seen as an opportunity for testing. This is a major issue for newborns infected with HIV who may benefit from the kind of early care and treatment critical to their survival (without care 50% of HIV infected children die before the age of 2).
If this policy is acceptable to parents and guardians, at least in high-prevalence countries, its feasibility for children under 18 months nevertheless depends on low-cost or free access to virological diagnostics. Advocacy continues!

The development of early testing through PCR is a major step forward in the care and treatment of infants exposed to HIV and allows early care of infants who are infected. Consequently, blood must be drawn from a larger number of newborns. Healthcare personnel often do not pay attention to the pain and stress caused by drawing blood. There are simple ways to decrease the pain that the infant experiences. Studies have shown that drinking breast milk or sugar water just before drawing blood significantly reduces manifestations of pain in the infant under three months old. The physiological mechanism described endogenously produces endorphins.
In practice, the child should be given the breast if s/he is breastfeeding, or bottle fed 1 to 2 ml of sucrose (dilute a standard sugar cube - 5 g - in 15 ml of potable water) or glucose at 30% (glucose serum in ampoules, also called G30) around 2 minutes before the heel stick. The infant can continue sucking throughout the drawing of blood. If we give him/her the sugar solution, the effectiveness lasts around 5 minutes and the infant can be given additional doses; the analgesic’s efficacy increases the infant keeps a nipple in his or her mouth.
This method of pain reduction can be used whether drawing blood from the infant’s vein or heel. It is simple to do and can improve the experience for the infant, the mother and the health care professional.

A second edition of this manual has just been published (some of you may have won the first edition as a prize when playing GROWING UP’s « Brain-Teaser»).
Regarding PMTCT, we would like to bring to your attention to the fact that the IMEA has asked the WHO to re-think their 2006 recommendations to include ARV triple therapy as prophylaxis for mothers who do not need this treatment for themselves, entirely replacing single dose Nevirapine and counseling these women on ARV-protected breastfeeding (see: authors recommendations, p.4).
For children under a year old who are known to be HIV positive or present clinical reasons to be suspected HIV positive, ART is recommended regardless of the CD4 count.
Stavudine (D4T) should no longer be used as part of a first line treatment but only as a replacement for zidovudine in cases of severe anemia or neutropenia and only for a maximum period of 6 months (See: author’s note, p. 52).