Improved employment and education outcomes in households of HIV-infected adults with high CD4 cell counts

Thirumurthy, Harsha; Chamie, Gabriel; Jain, Vivek; Kabami, Jane; Kwarisiima, Dalsone; Clark, Tamara D.; Geng, Elvin; Petersen, Maya; Charlebois, Edwin D.; Kamya, Moses R.; Havlir, Diane V.

doi:10.1097/qad.0b013e32835c54d8

Cited by 32 publications

(38 citation statements)

References 17 publications

(17 reference statements)

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“…While those initiating ART at CD4<200 caught up quickly and experienced similar trajectories thereafter, earlier ART initiation may have prevented households from experiencing job loss and economic hardship in the first place, consistent with recent findings by Thirumurthy, et al [15]. Focusing on labor force participation alone, however, may mask more subtle impacts of HIV on individual and household socioeconomic outcomes.…”

Section: Discussionsupporting

confidence: 83%

“…Earlier initiation may confer significant economic benefits as well. A growing body of work has shown that ART helps individuals resume employment after having been too sick to work [5-14]: earlier ART may prevent the pre-treatment declines in socioeconomic status altogether [15]. Moreover, earlier therapy may also augment subsequent economic recovery if those initiating ART at lower CD4 counts have difficulty achieving their pre-treatment economic status, perhaps due to reduced productivity from persistent morbidity or lower social mobility.…”

Section: Introductionmentioning

confidence: 99%

“…A recent study demonstrated that individuals with CD4>200 in a rural Ugandan parish had similar labor force participation rates as HIV negative individuals [15]. However, this study did not explicitly focus on individuals on ART, nor did it examine differences in economic outcomes over time.…”

Section: Introductionmentioning

confidence: 99%

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CD4+ cell count at antiretroviral therapy initiation and economic restoration in rural Uganda

Venkataramani

Thirumurthy

Haberer

et al. 2014

Aids

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Objective To determine whether earlier initiation of antiretroviral therapy (ART) is associated with better economic outcomes. Design Prospective cohort study of HIV positive patients on ART in rural Uganda. Methods Patients initiating ART at a regional referral clinic in Uganda were enrolled in the Uganda AIDS Rural Treatment Outcomes study (UARTO) starting in 2005. Data on labor force participation and asset ownership were collected on a yearly basis and CD4 counts were collected at pre-ART baseline. We fitted multivariable regression models to assess whether economic outcomes at baseline and in the 6 years following ART initiation varied by baseline CD4 count. Results 505 individuals, followed on average for 5 years, formed the estimation sample. Participants initiating ART at CD4≥200 were 13 percentage points more likely to be working at baseline (p<0.01, 95% CI 0.06-0.21) than those initiating below this threshold. Those in the latter group achieved similar labor force participation rates within 1 year of initiating ART (p<0.01 on the time indicators). Both groups had similar asset scores at baseline and demonstrated similar increases in asset scores over the 6 years of follow up. Conclusion ART helps participants initiating therapy at CD4<200 rejoin the labor force, though the findings for participants initiating with higher CD4 counts suggests that pre-treatment declines in labor supply may be prevented altogether with earlier therapy. Baseline similarities in asset scores for those with early and advanced disease suggest that mechanisms other than morbidity may help drive the relationship between HIV infection and economic outcomes.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

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CD4+ cell count at antiretroviral therapy initiation and economic restoration in rural Uganda

Venkataramani

Thirumurthy

Haberer

et al. 2014

Aids

Self Cite

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“…Although the costs associated with ART expansion may seem daunting, cost-effectiveness analyses continue to confirm the cost-savings associated with this approach. The overall economic benefits of returning individuals to the workforce must not be overlooked (38). Strategies to minimize losses along the care cascade continue to be evaluated and recommended using an evidence-based approach where possible (39), and in this context the secondary benefits of successful ART uptake can be maximized to reduce transmission events.…”

Section: Moving Forwardmentioning

confidence: 99%

Treatment as Prevention—Where Next?

2014

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Purpose of Review Uptake of antiretroviral regimens with durable virologic suppression has been shown to reduce the risk of HIV transmission. Expanding ART programs at a population-level may serve as a vital strategy in the elimination of the AIDS epidemic. Recent findings The global expansion of ART programs has greatly improved access to life-saving therapies, and is likely to achieve the target of 15 million individuals on therapy set by UNAIDS. In addition to the incontrovertible gains in terms of life expectancy, growing evidence demonstrates that durable virologic suppression is associated with significant reductions in HIV transmission amongst heterosexual couples and men who have sex with men. Expansion in successful ART programs, best monitored by a program-level continuum of care cascade to monitor progress in diagnosis, retention in care and virologic suppression, is associated with reductions in HIV incidence at a population level. Summary Expanding and sustaining successful ART delivery at a global level is a key component in a comprehensive approach to combating the HIV epidemic over the next two decades.

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“…Studies have shown that in a number of different settings there is no significant difference in the quality of care of patients who receive services from community health workers compared to those receiving health facility based care 5,[11][12][13] . In addition, there is no evidence to show if the PLWHAs are ready to utilize HIV services provided by community health workers of either sero-status.…”

Section: Introductionmentioning

confidence: 99%

Willingness by people living with HIV/AIDS to utilize HIV services provided by Village Health team workers in Kalungu district, central Uganda

Lubogo¹,

Anguzu

Wanzira

et al. 2017

Afr H. Sci.

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Background: Less than one quarter of people in need have access to HIV services in Uganda. This study assessed willingness of people living with HIV/AIDS (PLWHAs) to utilize HIV services provided by Village Health Teams (VHTs) in Kalungu district, central Uganda. Methods: A cross-sectional study conducted in two health facilities providing anti-retroviral therapy enrolled 312 PLWHAs. Pre-tested semi-structured questionnaires were administered to participants at household level. A forward fitting logistic regression model computed the predictors of willingness of PLWHAs to utilize services provided by VHTs. Results: Overall, 49% were willing to utilize HIV services provided by VHTs increasing to 75.6% if the VHT member was HIV positive. PLWHAs who resided in urban areas were more likely to utilize HIV services provided by VHTs (AOR 0.24, 95%CI 0.06-0.87). Barriers to utilizing HIV services provided by VHTs were: income level > 40 USD

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Improved employment and education outcomes in households of HIV-infected adults with high CD4 cell counts

Cited by 32 publications

References 17 publications

CD4+ cell count at antiretroviral therapy initiation and economic restoration in rural Uganda

CD4+ cell count at antiretroviral therapy initiation and economic restoration in rural Uganda

Treatment as Prevention—Where Next?

Willingness by people living with HIV/AIDS to utilize HIV services provided by Village Health team workers in Kalungu district, central Uganda

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