AFISE Description of the Precious Children Program

Description of the Precious Children Program at the Romanian Clinical Center of Excellence: 5 Years of Experience Introduction Thanks to the advances of HAART and to the establishment in 2001 of the Romanian American Children’s Centre (RACC), the HIV infected children and adolescents in Constanta County grew into young adults and had to face developmentally appropriate life tasks related to career, family and parenthood. As such, starting with 2005 the first children of patients in care at the former RACC were born. BBSF has formally set a complex PMTCT program in 2008; this program is recognized by the community as the PRECIOUS children (PC) program. Objectives   To prevent the transmission of HIV from mother to child.   Support for the HIV affected family in order to raise the precious children Materials, methods, results In 2012 in Constanta there were around 1000 people living with HIV/AIDS, 930 being over 20 years old. During the last years, in Romania there were 130.000 pregnant women per year and around 100.000 abortions. From the HIV infected children from the 90’s, who are now sexually active, between 2008-2012 there were 120 children (115 alive; 5 deaths) being born, 102 couples with the following structure: dis- cordant couples – 75 (in 63 of them the mother is HIV+ and in 12 the mother is HIV-) and 27 couples with both partners HIV+. The mothers’ level of schooling is: 12 of them illiterate, 17- finished primary school; 40- finished secondary school; 28- finished high school + university, meaning only 30% of them have higher education. The children’s demographic structure: 115 alive; 5 deaths 114 live with their families; 6 in foster homes; and 0 are institutionalized During their first 2 years of life, 75 children have received powder milk (donation from 2009). Among the 102 mothers, 17 have more than one child to which we add the pregnant women who will give birth in 2013; in conclusion 20% of the women with ages above 25 have 2-3 or even 4 children. 109 children were born from HIV+ mothers and 11 children were born from HIV- mothers. Among the 109 children, 97 are negative (72 with VL undetectable; 25 under evaluation but with VL undetectable at the first evaluations) and there are 5 deaths. single mothers married mothers women living with a partner Most of the pregnant women have given birth through caesarian – 86%, 85 of these children receiving an 8 at birth on the APGAR scale. 82 pregnant women have received TARV during their pregnancy (80%) (for the entire period or for at least a few months), 10 pregnant women didn’t receive TARV because they were found when they gave birth. All the new-born babies have received treatment. 4 mothers with AIDS have died (1 in an accident) because of TB meningitis, ruptured hydatid cyst and septicemia. Lessons learned HAART is safe and effective as a PMTCT intervention for the mother and the child, but HAART alone is not enough since the medical and psychosocial characteristics of our patients raise unique challenges that can only be overruled through a team’s approach. Conclusions   In Constanta we relatively have a lot of children being born from HIV infected people, their parents being the children from the ‘90’s.   The HIV transmission rate is very low, 1%, the children are growing normally.   There are many discordant couples, most of them with an HIV- father.   Many couples refuse to have protected sex.   Many births but also many abortions.   Many mothers with a low level of schooling.   The Precious Children live with their families they are not institutionalized.   The great majority have a normal development, this is due to the permanent monitoring of the child, the pregnant woman and that of the mother and also due to respecting the birth/therapy/food standards.   A relatively big percentage – 20% of the mothers with more than 1 child are under 25 years old. Next steps Although successful, the PMTCT program needs to enhance its prevention components: family planning, TB prophylaxis, immunizations, behavioral medicine for life style changes. Authors: Rodica Mătușa 1 , Luiza Vlahopol 1 , Costandache Cristian 1 , Anca Andrei 1 , Mihai Rodica 1 , Negivan Septar 1 , Angelica Butuc 1 , Niculaie Florica 1 , Emanoil Vasiliu 1 , Mirela Paraschiv 1 , Gabriela Bâzâitu 1 , Simona Vlase 1 , Pop Corina 1 , Claudia Cambrea 2 , Tanase Doina 2 , Ilie Margareta 2 1 Baylor Black Sea Foundation – BBSF, 2 Infectious Diseases Hospital Constanța, România