In a study of a population cohort in South Africa, HIV patients on antiretrovirals had nearly full recovery of employment

Abstract

Antiretroviral therapy for HIV may have important economic benefits for patients and their households. We quantified the impact of HIV treatment on employment status among HIV patients in rural South Africa who were enrolled in a public-sector HIV treatment program supported by the President's Emergency Plan for AIDS Relief. We linked clinical data from more than 2,000 patients in the treatment program with ten years of longitudinal socioeconomic data from a complete community-based population cohort of more than 30,000 adults residing in the clinical catchment area. We estimated the employment effects of HIV treatment in fixed-effects regressions. Four years after the initiation of antiretroviral therapy, employment among HIV patients had recovered to about 90 percent of baseline rates observed in the same patients three to five years before they started treatment. Many patients initiated treatment early enough that they were able to avoid any loss of employment due to HIV. These results represent the first estimates of employment recovery among HIV patients in a general population, relative to the employment levels that these patients had prior to job-threatening HIV illness and the decision to seek care. There are large economic benefits to HIV treatment. For some patients, further gains could be obtained from initiating antiretroviral therapy earlier, prior to HIV-related job loss.

EXHIBIT 1. Immunological Recovery Among HIV Patients Receiving Antiretroviral Therapy

SOURCE Authors’ analysis of data from the Hlabisa HIV Treatment and Care Programme. NOTES Crude trends in CD4+ lymphocyte counts, as explained in text. Analysis includes 372 patients in the Hlabisa HIV Treatment and Care Programme who initiated treatment before December 31, 2006, and had a CD4+ lymphocyte count within the six months prior to initiation. CD4+ lymphocyte counts were imputed as zero following date of death and as “last observed” for loss to follow-up other than death. Eighty-five percent of the patients were alive after four years of treatment.

EXHIBIT 2. Crude Employment Trend Among HIV Patients Receiving Antiretroviral Therapy

SOURCE Authors’ analysis of data from the Hlabisa HIV Treatment and Care Programme and Africa Centre for Health and Population Studies. NOTE The crude trend is estimated by local linear regression, with a bandwidth of 200 days.

EXHIBIT 3. Regression-Adjusted Employment Trend Among HIV Patients Receiving Antiretroviral Therapy

SOURCE Authors’ analysis of data from the Hlabisa HIV Treatment and Care Programme and Africa Centre for Health and Population Studies. NOTES Data are coefficients from a fixed effects linear probability model described in the text and shown in Column 1 of Exhibit 4. Ninety-five percent confidence intervals are adjusted for clustering at the individual level.

EXHIBIT 5. Probability Of Finding Work After Job Loss For HIV Patients Receiving Antiretroviral Therapy And Matched Controls

SOURCE Authors’ analysis of data from the Hlabisa HIV Treatment and Care Programme and Africa Centre for Health and Population Studies. NOTES Curves are Kaplan-Meier failure curves for jobless spells (failure is defined as regaining employment). Jobless spells for patients were included if they began within three years of the initiation of antiretroviral treatment. Controls were exact-matched to patients by year of birth, sex, education, year of job loss, and place of residence when last employed. The sample included the jobless spells of 213 HIV patients and 805 matched controls. See Appendix for further details on sample construction and survival analysis methods.