South African HIV patients on ART experience nearly complete recovery of employment
10 July 2012
Somkhele, South Africa – HIV patients receiving antiretroviral therapy (ART) in the public sector treatment programme experienced nearly complete recovery of employment, a new study finds. The study, conducted by researchers at the Africa Centre for Health and Population Studies of the University of KwaZulu-Natal, was published today in the July issue of Health Affairs, a leading health policy journal.
Four years after initiation of antiretroviral therapy, employment among HIV patients had recovered to about 90 percent of baseline rates observed in those same patients three to five years before they started treatment. Many patients initiated treatment early enough so that they were able to avoid any loss of employment due to HIV.
“This study provides some of the strongest evidence yet of the large economic benefits that South Africa’s treatment programme has had for people with HIV and their households,” said the study’s lead author, Jacob Bor, of the Africa Centre and Harvard School of Public Health.
The study included over 30,000 working age adults (18-59 years) living in a community in Umkhanyakude District, KwaZulu-Natal. Ten years of socioeconomic data were collected on these people from 2001 through 2010 by the Africa Centre, as part of its ongoing population and health surveillance programme. The community where the study took place is mostly rural, and suffers from high HIV prevalence (28% of adults) and very high unemployment.
Since 2004, more than 2000 adults in the study initiated antiretroviral therapy in the government HIV treatment programme that serves the community. In an agreement with the Department of Health, the Africa Centre was able to link these patients’ clinical records with their socioeconomic data.
“Because of the unique data collected by the Africa Centre,” said Mr. Bor, “for the first time, it was possible to measure changes in employment among HIV patients relative to levels of employment in these same patients, years before job-threatening HIV illness and the decision to seek care. This critical baseline had eluded previous clinical studies.” The researchers were also able to adjust for changes in local economic opportunities over time, and were able to observe employment even for non-resident household members who migrated temporarily for work.
“As this study shows, the economic benefits of ART are very large. In South Africa, where 3 million people are expected to be on ART by 2020, these benefits will be widely enjoyed,” said Till Bärnighausen, Senior Epidemiologist at the Africa Centre, Associate Professor at Harvard School of Public Health, and the study’s senior author.
For some patients, further benefits could be attained from initiating treatment earlier, prior to HIV-related job loss. Patients in the study who lost work prior to starting ART experienced long jobless spells, over 3 years on average. However, the researchers were surprised to find that these patients fared no worse than other community members in returning to work after job loss.
“We expected that obstacles such as incomplete health recovery, treatment side effects, barriers to labor migration, and discrimination would heavily disadvantage HIV patients on ART in returning to work,” said Mr. Bor. “However, we found that in cases of job loss, 90% of time out of work for HIV patients could be explained by factors faced by similar workers in the general population.”
To avoid long periods without work for HIV patients, efforts should be made to recruit people with HIV into care and treatment earlier, to avoid job loss altogether. Information on the economic benefits of ART could be used to encourage earlier HIV testing and care-seeking. Further, employers should work more closely with government health systems to encourage and facilitate HIV testing and utilization of clinical services for HIV, for example, providing time for employees to visit the clinic.
The researchers highlighted the importance of pairing ART rollout with job creation policies. Although employment among HIV patients recovered nearly to baseline, the study took place in a community where only 37 percent of the working age population is employed.
“By and large, HIV patients receiving ART are able to work – if there are jobs available. Much larger economic benefits of HIV treatment will be possible, with greater employment opportunities for all South Africans,” said Mr. Bor. “Our findings indicate that job creation efforts should be sensitive to the needs of people with HIV on ART, but should not prioritize people with HIV over the general population.”
“Most importantly,” said Prof. Marie-Louise Newell, Director of the Africa Centre, “the full economic benefits of HIV treatment will be realized only with a long-term commitment to universal treatment access.”
The study was funded by the Wellcome Trust (UK), National Institute of Child Health and Human Development (USA), and Harvard Global Health Institute (USA).
The study can be found here: http://content.healthaffairs.org/content/31/7/1459.abstract