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High CD4 counts associated with better economic outcomes for HIV-positive adults and their HIV-negative household members in the SEARCH Trial

Author

Listed:
  • Aleksandra Jakubowski
  • Katherine Snyman
  • Dalsone Kwarisiima
  • Norton Sang
  • Rachel Burger
  • Laura Balzer
  • Tamara Clark
  • Gabriel Chamie
  • Starley Shade
  • Craig Cohen
  • Elizabeth Bukusi
  • Edwin Charlebois
  • Moses Kamya
  • Maya Petersen
  • Diane Havlir
  • Harsha Thirumurthy

Abstract

Background: Country decisions to scale-up “test and treat” approaches for HIV depend on consideration of both the health and economic consequences of such investments. Evidence about economic impacts of expanded antiretroviral therapy (ART) provision is particularly relevant for decisions regarding foreign assistance levels for HIV/AIDS programs. We used baseline data from the Sustainable East Africa Research in Community Health (SEARCH) cluster randomized controlled trial in Kenya and Uganda to examine the association between HIV status, CD4+ T-cell counts, viral suppression, and multiple indicators of economic well-being. Methods and findings: Socio-economic surveys were conducted in households with HIV-positive and HIV-negative adults sampled after a census of 32 communities participating in the SEARCH trial (NCT01864603). Data were obtained for 11,500 individuals from 5,884 households in study communities. Participants were stratified based on their own HIV status as well as CD4 counts and viral suppression status if they were HIV-positive. HIV-negative participants residing in households with no HIV-positive adults were considered separately from HIV-negative participants residing in households with ≥1 HIV-positive adult. Generalized estimating equation models were used to examine the relationship between HIV status, CD4 counts, ART, viral suppression, and outcomes of employment, self-reported illness, lost time from usual activities due to illness, healthcare utilization, health expenditures, and hospitalizations. In all models, HIV-negative participants in households with no HIV-positive persons were the reference group. Conclusions: Data from a large population-representative sample of households in east Africa showed a strong association between the health of HIV-positive persons and economic outcomes. The findings suggest there may be economic benefits associated with maintaining high CD4 counts, both for HIV-positive persons and their HIV-negative household members. The association of high CD4 counts with improved outcomes is consistent with the hypothesis that early ART initiation can avert declines in employment and other economic outcomes. Prospective longitudinal evaluation is needed to assess the causal impact of early ART initiation on economic functioning of households.

Suggested Citation

  • Aleksandra Jakubowski & Katherine Snyman & Dalsone Kwarisiima & Norton Sang & Rachel Burger & Laura Balzer & Tamara Clark & Gabriel Chamie & Starley Shade & Craig Cohen & Elizabeth Bukusi & Edwin Char, 2018. "High CD4 counts associated with better economic outcomes for HIV-positive adults and their HIV-negative household members in the SEARCH Trial," PLOS ONE, Public Library of Science, vol. 13(6), pages 1-18, June.
    • Handle: RePEc:plo:pone00:0198912
    DOI: 10.1371/journal.pone.0198912
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    References listed on IDEAS

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