Abstract

THAE0102 - Oral Abstract Session

Improved employment and children's education outcomes in households of HIV-positive adults with high CD4 counts: evidence from a community-wide health campaign in Uganda

Presented by Harsha Thirumurthy (United States).

H. Thirumurthy¹, G. Chamie^2,3, J. Kabami³, V. Jain^2,3, T. Clark^2,3, D. Kwarisiima⁴, E. Geng^2,3, M.L. Petersen⁵, M.R. Kamya^3,6, E.D. Charlebois^2,7, D.V. Havlir^2,3, and the SEARCH Collaboration

¹University of North Carolina at Chapel Hill, Department of Health Policy and Management, Chapel Hill, United States, ²University of California, San Francisco, HIV/AIDS Division, Department of Medicine, San Francisco, United States, ³Makerere University-University of California, San Francisco (MU-UCSF) Research Collaboration, Kampala, Uganda, ⁴Mulago-Mbarara Joint AIDS Program, Mbarara, Uganda, ⁵University of California at Berkeley, School of Public Health, Berkeley, United States, ⁶Makerere University Medical School, Kampala, Uganda, ⁷Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, United States

Background: Despite growing evidence that socio-economic outcomes among HIV-infected adults show improvement after antiretroviral therapy (ART) initiation, little is known about the variation in these outcomes among a population that also includes individuals with high CD4 counts and those not enrolled in care. We examined associations between CD4 count and socio-economic outcomes among adults participating in a community-wide health campaign in a rural Ugandan parish.
Methods: A one-week community health campaign offering diagnostic and treatment services for HIV and other infectious and non-communicable diseases was conducted in May 2011. Data on campaign participants´ employment were collected, and a detailed household socio-economic survey was conducted among a random subset of participants. Multivariable regression was used to assess relationships between CD4 count and employment and educational outcomes.
Results: 2,323 adults (74% of the community) participated in the campaign. 179 adults (7.8%) tested HIV-positive and 46% were newly diagnosed. HIV-positive adult participants with CD4 >550 and 350-550 worked 4.8 and 5.3 more days during the past month than those with CD4 < 200 (p< 0.05). No differences in work patterns were found between participants with CD4 200-350 and < 200. The association was similar among those on ART and not on ART. Children's school enrollment was also associated with adults´ CD4 counts. Children in households of adults with CD4 >350 had 20% higher school enrollment rates than children in households of adults with CD4 < 200 (p< 0.05). Finally, socio-economic outcomes of HIV-participants with high CD4 counts resembled those of HIV-negative participants.
Conclusions: Outcomes of HIV-positive adults with high CD4 counts are not only better than those of adults with low CD4 counts, they also resemble those of HIV-negative adults. Early initiation of ART could generate economic benefits by preventing a decline in employment and education outcomes and maintaining them at levels seen among HIV-negative peers.