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.
