Abstract
South Africa's paediatric antiretroviral therapy (ART) programme is managed using a monitoring and evaluation tool known as TIER.Net. This electronic system has several advantages over paper-based systems, allowing profiling of the paediatric ART programme over time. We analysed anonymized TIER.Net data for HIV-infected children aged <15 years who had initiated ART in a rural district of South Africa between 2005 and 2014. We performed Kaplan-Meier survival analysis to assess outcomes over time. Records of 5461 children were available for analysis; 3593 (66%) children were retained in care. Losses from the programme were higher in children initiated on treatment in more recent years (P < 0·0001) and in children aged ≤1 year at treatment initiation (P < 0·0001). For children aged <3 years, abacavir was associated with a significantly higher rate of loss from the programme compared to stavudine (hazard ratio 1·9, P < 0·001). Viral load was suppressed in 48-52% of the cohort, with no significant change over the years (P = 0·398). Analysis of TIER.Net data over time provides enhanced insights into the performance of the paediatric ART programme and highlights interventions to improve programme performance.
Highlights
To highlight the importance of the availability of such data, we present an analysis of the paediatric antiretroviral therapy (ART) programme using routine TIER
Records were excluded where tenofovir disoproxil fumarate (TDF) had been captured in the ART regimen in order to avoid misclassification of adults as children through incorrect capturing of birth dates, as this drug is only indicated for individuals aged 515 years according to South African guidelines [15]
The paediatric ART programme in Mopani has expanded over time, with new ART initiations increasing steadily from 2005 to 2011, followed by a marginal decrease in 2014 (Fig. 1)
Summary
Data source and study designWe analysed routinely available, anonymized TIER. Net data for children initiating ART in Mopani district of Limpopo Province, South Africa, which has an antenatal HIV prevalence of 24·6% [14]. Net data for children initiating ART in Mopani district of Limpopo Province, South Africa, which has an antenatal HIV prevalence of 24·6% [14]. The following criteria were used to select records for inclusion in the study: child aged
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