Explaining an HIV-exposed infant's diagnosis and feeding plan — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar on the postnatal ward. A term, well infant has just been born to a 28-year-old mother who was diagnosed with HIV at 24 weeks of pregnancy and started on combination antiretroviral therapy; her viral load is now suppressed. [7]

Your tasks are: [7]

1. Explain why the baby's HIV antibody test will be positive but does not mean the baby is infected, and how infection will actually be confirmed or excluded. [7]
2. Explain the infant's medication — nevirapine prophylaxis and, from a few weeks, cotrimoxazole — and what each is for. [7] [8]
3. Explain the HIV PCR testing schedule, including the final antibody test at 18 to 24 months. [7]
4. Advise on infant feeding, and explain how the mother's own viral suppression is the most important protection for the baby. [3] [7]

You are not expected to adjust the mother's own HIV medications — her HIV physician retains that — but you should reinforce the importance of her staying on treatment and engaged in care. [7]