Page 51 - Children Bookt.pdf

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The detection of new or recurrent WHO clinical stage 3 or 4 events in a child on

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provided the child is adherent to therapy.

YK[ Management by using WHO clinical staging of events to guide decision-
making on switching to second-line therapy for treatment failure
New or recurrent clinical event develops Management options c,d
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&>@ a,b
No new events or stage 1 events Do not switch to new regimen
Maintain regular follow-up
Stage 2 events Treat and manage event
Do not switch to a new regimen
Assess adherence and offer support
Assess nutritional status and offer support
Schedule earlier visit for clinical review
and CD4 measurement
Treat and manage event and monitor
Stage 3 events
response
e
Check if on treatment 24 weeks or more
Assess adherence and offer support
Assess nutritional status and offer support
Check CD4 where available
f
Institute early follow-up
#% Treat and manage event
Check if on treatment 24 weeks or more
Assess adherence and offer support
Assess nutritional status and offer support
f
Check CD4 where available
Consider switching regimen

(a)
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WHO clinical staging at the time of evaluating the infant or child on ART.
;&Uj= provides more details about clinical events.
(b) It needs to be ensured that the child has had at least 24 weeks of treatment and
that adherence to therapy has been assessed and considered adequate before
considering switching to a second-line regimen.
(c) Differentiating OIs from IRIS is important.

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