PLHIV have decreased economic productivity both due to direct and indirect causes. Data from developed countries have shown that at the societal level, high costs ART are offset by increased productivity. We hypothesized that post-ART the SES would improve regardless of the baseline SES and will be sustained over time. Our objective was to perform a comprehensive SES evaluation pre/post ART initiation using an ambispective cohort study design. We used Indian household-specific SES validated tool, with score of <15 being=\"\" indigent=\"\" to=\"\">76 being affluent, along with clinical, ART adherence data at median of 6 and 18 months post ART, and compared using paired t-tests. Among 140 persons started on ART, with a median follow up of 22 months, 118 had Pre-ART SES data, of these: 57% were women; median age was 38 years; 67% were married; 89 (78%) had heterosexual sex as HIV risk; 40 (34%) had major OI and/or TB at presentation. Reported self-occupation was: skilled labourers 41 (35%); 12 (10%) unskilled labourers; 27 (23%) housewives; 26 (22%) pro-fessionals/blue collar job; 1 student, 10 unemployed. The median pre-post ART CD4 cell counts were: 187 and 454 cells/cumm (P < 0.01); median body weight pre-post ART was 54 and 57 kg (P < 0.01); 97% of the participants were 100% adherent. The mean Pre-ART total SES score was 37.06 (+/-10.2); and Post-ART SES score 40.62 (+10.1 P < 0.001) and these results were sustained over time and remained significant even when only monthly income was considered. Our data show a significant impact of ART on SES in a sustained manner in a developing world setting, which has policy level implications.
References
[1]
(2017) UNAIDS Global Report. http://www.unaids.org/en/resources/campaigns/globalAIDSupdate2017
[2]
Greener, R. (1998) Why Companies Should Intervene: A Case Study of the Costs of HIV/AIDS to Employers. Economic Impact: Southern Africa. AIDS Analysis Africa, 8, 3-4.
[3]
Greener, R. (2002) AIDS and Macroeconomic Impact. In: Forsyth, S., Ed., State of the Art: AIDS and Economics, IAEN, 49-55.
[4]
Hanson, K. (1992) AIDS: What Does Economics Have to Offer? Health Policy and Planning, 7, 315-328. https://doi.org/10.1093/heapol/7.4.315
[5]
Morris, C.N. and Cheevers, E.J. (2000) The Direct Costs of HIV/AIDS in a South African Sugar Mill. AIDS Analysis Africa, 10, 7-8.
[6]
Over, M. (1992) The Macroeconomic Impact of AIDS in Sub-Saharan Africa. Population and Human Resources Department, The World Bank, 1-39.
[7]
Over, M., Revenga, A., Masaki, E., Peerapatanapokin, W., Gold, J., Tangcharoensathien, V. and Thanprasertsuk, S. (2007) The Economics of Effective AIDS Treatment in Thailand. AIDS, 21, S105-S116. https://doi.org/10.1097/01.aids.0000279713.39675.1c
[8]
Economic Impact of HIV. http://en.wikipedia.org/wiki/AIDS
[9]
National AIDS Control Organisation (NACO) (2006). www.nacoonline.org
[10]
Beard, J., Feeley, F. and Rosen, S. (2009) Economic and Quality of Life Outcomes of Antiretroviral Therapy for HIV/AIDS in Developing Countries: A Systematic Literature Review. AIDS Care, 21 1343-1356. https://doi.org/10.1080/09540120902889926
[11]
Bender, M.A., Kumarasamy, N., Mayer, K.H., Wang, B., Walensky, R.P., Flanigan, T., Freedberg, K.A., et al. (2010) Cost-Effectiveness of Tenofovir as First-Line Antiretroviral Therapy in India. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 50, 416-425. https://doi.org/10.1086/649884
[12]
Palella Jr., F.J., Delaney, K.M., Moorman, A.C., Loveless, M.O., Fuhrer, J., Satten, G.A. and Holmberg, S.D. (1998) Declining Morbidity and Mortality among Patients with Advanced Human Immunodeficiency Virus Infection. HIV Outpatient Study Investigators. The New England Journal of Medicine, 338, 853-860. https://doi.org/10.1056/NEJM199803263381301
[13]
Sendi, P., Palmer, A.J., Gafni, A. and Battegay, M. (2001) Highly Active Antiretroviral Therapy: Pharmacoeconomic Issues in the Management of HIV Infection. Pharmacoeconomics, 19, 709-713. https://doi.org/10.2165/00019053-200119070-00001
[14]
Bozzette, S.A., Joyce, G., McCaffrey, D.F., Leibowitz, A.A., Morton, S.C., Berry, S.H., Goldman, D.P., et al. (2001) Expenditures for the Care of HIV-Infected Patients in the Era of Highly Active Antiretroviral Therapy. The New England Journal of Medicine, 344, 817-823. https://doi.org/10.1056/NEJM200103153441107
[15]
Bendavid, E., Wood, R., Katzenstein, D.A., Bayoumi, A.M. and Owens, D.K. (1999) Expanding Antiretroviral Options in Resource-Limited Settings—A Cost-Effectiveness Analysis. Journal of Acquired Immune Deficiency Syndromes, 52, 106-113. https://doi.org/10.1097/QAI.0b013e3181a4f9c4
[16]
Freedberg, K.A., Kumarasamy, N., Losina, E., Cecelia, A.J., Scott, C.A., Divi, N., Walensky, R.P., et al. (2007) Clinical Impact and Cost-Effectiveness of Antiretroviral Therapy in India: Starting Criteria and Second-Line Therapy. AIDS (London, England), 21, S117-S128. https://doi.org/10.1097/01.aids.0000279714.60935.a2
[17]
Valenti, W.M. (2001) HAART Is Cost-Effective and Improves Outcomes. The AIDS Reader, 11, 260-262.
[18]
Solomon, S., Batavia, A., Venkatesh, K.K., Brown, L., Verma, P., Cecelia, A.J., Mayer, K.H., et al. (2009) A Longitudinal Quality-of-Life Study of HIV-Infected Persons in South India: The Case for Comprehensive Clinical Care and Support Services. AIDS Education and Prevention: Official Publication of the International Society for AIDS Education, 21, 104-112. https://doi.org/10.1521/aeap.2009.21.2.104
[19]
Aggarwal, O.P., Bhasin, S.K., Sharma, A.K., Chhabra, P., Aggarwal, K. and Rajoura, O.P. (2005) A New Instrument (Scale) for Measuring the Socioeconomic Status of a Family: Preliminary Study. Indian Journal of Community Medicine, 30, 305-310.
[20]
Orlando, S., Alumando, E.S., Marazzi, M.C., Germano, P., Guidotti, G., Gennaro, E., Ciccacci, F. and Palombi, L. (2012) The Impact of Anti-Retorviral Therapy on the Social, Economic and Working Conditions of Patients with HIV/AIDS in Malawi. XIX International AIDS Conference, Washington DC, 22-27 July 2012, E1-E66.
[21]
Thirumurthy, H., Jafri, A., Srinivas, G., Arumugam, V., Saravanan, R.M., Angappan, S.K., Kallolikar, S., et al. (2011) Two-Year Impacts on Employment and Income among Adults Receiving Antiretroviral Therapy in Tamil Nadu, India: A Cohort Study. AIDS (London, England), 25, 239-246. https://doi.org/10.1097/QAD.0b013e328341b928
[22]
Nachega, J.B., Leisegang, R., Bishai, D., Nguyen, H., Hislop, M., Cleary, S. and Maartens, G. (2010) Association of Antiretroviral Therapy Adherence and Health Care Costs. Annals of Internal Medicine, 152, 18-25. https://doi.org/10.7326/0003-4819-152-1-201001050-00006
[23]
National AIDS Control Organisation (NACO) (2010). http://www.nacoonline.org
[24]
Thirumurthy, H., Zivin, J.G. and Goldstein, M. (2008) The Economic Impact of AIDS Treatment: Labor Supply in Western Kenya. The Journal of Human Resources, 43, 511-552. https://doi.org/10.3368/jhr.43.3.511
