Jeena PM, McNally LM, Stobie M, Coovadia HM, Adhikari MA, Petros AJ; International Conference on AIDS (15th : 2004 : Bangkok, Thailand).
Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. TuPeB4458.
Nelson R Mandela School of Medicine, Durban, South Africa
Issues: World-wide, 2.8 million children are living with HIV/AIDS. Over 90% live in Sub-Saharan Africa where resources and healthcare are most limited. The demands on Paediatric Intensive Care Units are potentially overwhelming. In KwaZulu-Natal, South Africa we face daily the ethical dilemma of who to ventilate in an overstretched service. Description: We have examined current practice and the ethics of admitting HIV infected children to Intensive Care Units in resource constrained settings. Lessons Learned. An HIV infected child admitted to a PICU will encounter any or even all of the following problems: 1. The limited availability of accurate laboratory testing for HIV, especially HIV PCR. 2. Difficulty in accurate diagnosis of opportunistic infections. 3. HIV counselling of their family at a stressful time. 4. A variable Standard of Care dependent on where and when they are admitted. 5. A well reported poor outcome if he/she requires mechanical ventilation. There are three main ethical questions raised: 1. Are there clinical and moral reasons for admitting HIV infected children to the PICU? 2. Should resources be committed to caring for HIV infected children who require PICU 3. How can candidates for PICU be morally chosen? Recommendations: Currently, PICUs in South Africa and other resource constrained settings can not afford the luxury of a treating all children requiring their care (deontological approach). A more utilitarian view has to apply with clinicians being forced to decide who is admitted and who is not. However, with the increased funds available for HIV care and changing practice including the use of ARVs, this must be continually reviewed. The increased burden that HIV causes on PICU facilities including the ethical and moral dilemmas faced by staff must be included in any HIV management strategy.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Africa South of the Sahara
- Child
- Counseling
- Delivery of Health Care
- Developing Countries
- HIV Infections
- HIV Seropositivity
- Health Resources
- Humans
- Intensive Care
- Intensive Care Units, Pediatric
- Poverty
- South Africa
Other ID:
UI: 102282280
From Meeting Abstracts