Lilian R R, Mutasa B, Railton J, Mongwe W, McINTYRE J A, Struthers H E, Peters R P H
Anova Health Institute,Johannesburg and Tzaneen,South Africa.
Mopani Department of Health,Giyani,South Africa.
Epidemiol Infect. 2017 Jan;145(1):170-180. doi: 10.1017/S0950268816001916. Epub 2016 Sep 9.
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.
南非的儿科抗逆转录病毒疗法（ART）项目使用一种名为TIER.Net的监测和评估工具进行管理。与纸质系统相比，这个电子系统有几个优点，能够对儿科ART项目进行长期剖析。我们分析了2005年至2014年间在南非一个农村地区开始接受ART治疗的15岁以下HIV感染儿童的匿名TIER.Net数据。我们进行了Kaplan-Meier生存分析以评估随时间推移的结果。有5461名儿童的记录可供分析；3593名（66%）儿童持续接受治疗。近年来开始治疗的儿童以及治疗开始时年龄≤1岁的儿童退出该项目的比例更高（P<0.0001）。对于3岁以下儿童，与司他夫定相比，阿巴卡韦导致退出该项目的比例显著更高（风险比1.9，P<0.001）。该队列中48%-52%的儿童病毒载量得到抑制，多年来无显著变化（P=0.398）。对TIER.Net数据的长期分析能更深入地了解儿科ART项目的表现，并突出改善项目表现的干预措施。
