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Challenges in the provision of ICU services to HIV infected children in resource poor settings: a South African case study

¹ Nelson R Mandela School of Medicine, University of Natal, Durban, South Africa
² Institute of Child Health, London, UK
³ Unilever Ethics Centre School of Human and Social Studies, University of Natal, Durban, South Africa
⁴ Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children NHS Trust, London, UK

Correspondence to:
Dr P Jeena
Nelson R Mandela School of Medicine, University of Natal, Durban, South Africa; jeena{at}nu.ac.za
ABSTRACT
The HIV/AIDS epidemic has placed increasing demands on limited paediatric intensive care services in developing countries. The decision to admit HIV infected children with Pneumocystis carinii pneumonia (PCP) into the paediatric intensive care unit (PICU) has to be made on the best available evidence of outcome and the ethical principles guiding appropriate use of scarce resources. The difficulty in confirming the diagnosis of HIV infection and PCP in infancy, issues around HIV counselling, and the variance in the outcome of HIV infected children with PCP admitted to the PICU in African studies compound this process. Pragmatic decision making will require evaluation of at least three ethical questions: are there clinical and moral reasons for admitting HIV positive children with PCP to the PICU, should more resources be committed to caring for HIV children who require the PICU, and how can we morally choose candidates for the PICU? Those working in the PICU in HIV endemic regions need to make difficult personal decisions on effective triage of admissions of HIV infected children with PCP based on individual case presentation, availability of resources, and applicable ethical principles.

Abbreviations: ART, antiretroviral treatment; ELISA, enzyme linked immunosorbent antibody assay; ICU, intensive care unit; KEH, King Edward Hospital; MTCT, mother-to-child transmission; PCP, Pneumocystis carinii pneumonia; PICU, paediatric intensive care unit

Keywords: HIV; ICU; children; infection; developing world

This article has been cited by other articles:

				C Cowburn, M Hatherill, B Eley, J Nuttall, G Hussey, L Reynolds, Z Waggie, L Vivian, and A Argent Short-term mortality and implementation of antiretroviral treatment for critically ill HIV-infected children in a developing country Arch. Dis. Child., March 1, 2007; 92(3): 234 - 241. [Abstract] [Full Text] [PDF]