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. Chamie2,3, J. Kabami3, V. Jain2,3, T. Clark2,3, D. Kwarisiima4, E. Geng2,3, M.L. Petersen5, M.R. Kamya3,6, E.D. Charlebois2,7, D.V. Havlir2,3, 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.
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