Antiretroviral treatment helps keep HIV patients in South Africa employed

July 16, 2012 – Antiretroviral drug treatment for HIV appears to have more payoffs than the promise of better health and a longer life – it also seems to help people living with HIV stay employed or get new jobs, according to a new study by researchers at Harvard School of Public Health (HSPH) and the University of KwaZulu-Natal’s Africa Centre for Health and Population Studies. In a study of a large population cohort, the investigators found that four years after initiating therapy, HIV patients were 90% as likely to be working as they were three to five years before starting treatment. Many patients initiated treatment early enough so that they were able to avoid any loss of employment due to HIV.

While antiretroviral therapies are known to reduce HIV transmission and prolong lives of many HIV patients, less is known about the economic benefits of treatment. This is the first study to assess the economic impact of antiretroviral therapy (ART) in a population-based cohort.

“We found antiretroviral therapy does not only postpone mortality, it enables HIV patients to lead economically productive lives,” said lead author Jacob Bor, SD ’14, an HSPH doctoral candidate in global health and population.

The study appears in the July 2012 issue of Health Affairs.

The HSPH researchers analyzed 10 years of employment data on over 30,000 working age adults living in the Umkhanyakude District, KwaZulu-Natal. The community where the study took place is mostly rural, has a high HIV prevalence (28% of adults), and high unemployment. Since 2004, more than 2,000 adults in the database initiated antiretroviral therapy in the public sector treatment program that serves the community. In an agreement with the Department of Health, the Africa Centre was able to link these patients’ clinical records with the employment data.

The treatment program has received funding from the Presidents Emergency Plan for AIDS Relief (PEPFAR) program, a multi-billion dollar commitment undertaken by the U.S. government to expand access to HIV treatment and prevention services in the world’s hardest-hit regions. The July 2012Health Affairs features several articles examining the impact of the PEPFAR program.

“This study provides some of the strongest evidence yet of the large economic benefits that PEPFAR-funded treatment programs have had for people with HIV and their households,” said Bor. “For the first time, we were able to assess employment recovery relative to levels observed in those same patients before any job-threatening illness. We also were able to control for secular changes in local employment opportunities, and to observe patients even if they were lost to clinical follow-up.”

Although employment recovered nearly completely, the researchers found that patients who lost work prior to initiating treatment experienced long jobless spells, over three years on average. However, the length of time out of work appeared to be due to the scarcity of employment opportunities in this community, rather than an inability of patients receiving treatment to work. HIV patients fared no worse than other matched community members in returning to work after job loss.

“Our results suggest that further gains in economic well-being for HIV patients could be achieved through recruitment into care and treatment prior to job loss. Many patients seek care only after they have become quite sick. Interventions to improve take-up of HIV testing and linkage into care are needed to avoid costly job loss,” said senior author Till Bärnighausen, associate professor at HSPH and senior epidemiologist at the Africa Centre. “We plan to share our findings widely with people living with HIV, their employers, and policy makers, in order to facilitate earlier treatment initiation.”

Support for the study was provided by the Wellcome Trust, the National Institutes of Health’s (NIH) National Institute of Child Health and Human Development (grant R01 HD058482-01), and National Institute of Mental Health (grant 1R01MH083539-01), and the Harvard Global Health Institute.

–Marge Dwyer