An audit assessing data quality, viral suppression, and transition to dolutegravir among children and adolescents with HIV in care at eThekwini Municipality, South Africa
Discuss this preprint
Start a discussion What are Sciety discussions?Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
The 2023 South African antiretroviral therapy (ART) guidelines recommend dolutegravir-based ART for children and adolescents with HIV (CAWH) >4 weeks old, including transition to dolutegravir-based ART if previously taking another regimen.
Objectives
We audited uptake of dolutegravir-based ART, viral load (VL) testing, and viral suppression among CAWH in care in eThekwini, South Africa. We also aimed to assess and improve the quality of routinely collected ART and VL data in the national HIV electronic register (TIER.Net) in this population.
Methods
We used TIER.Net line lists to identify CAWH aged ≤19 years in care in 54 eThekwini Municipality clinics between February and July 2025. CAWH who had died, transferred out, or were lost to follow-up were excluded. We reviewed clinical files and TIER.Net records simultaneously to compare all recorded ART regimens and recent (last 12 months) VL results. High or missing VLs were flagged for medical review, and data discrepancies were corrected.
Results
Among 3838 eligible CAWH, we reviewed files of 3379 (88%). 1991 (59%) were female and 2812 (83%) were aged 10-19 years. All 3379 (100%) were receiving dolutegravir-based ART. 193 (6%) had no recent VL result. Of those who did, 303 (10%) had a last VL ≥1000 copies/mL. We identified 941 (28%), 438 (13%), and 199 (6%) TIER.Net data capture errors for ART regimens, ART regimen start/stop dates, or recent VLs, respectively.
Conclusion
This audit at 54 facilities showed complete transition to dolutegravir among reviewed files of CAWH in care, but highlighted gaps in viral suppression and documentation.
