Geneva Health Forum Archive

Browse and download abstracts, posters, documents and videos from past editions of the GHF

Economic Benefits of Antiretroviral Therapy for HIV/AIDS Patients in Nigeria.

Author(s) Kingsley Nnanna Ukwaja1.
Affiliation(s) 1Department of Medicine, , Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria, Abakaliki, Ebonyi State, Nigeria 2
Country - ies of focus Nigeria
Relevant to the conference tracks Infectious Diseases
Summary Little is known about the economic benefits of antiretroviral therapy (ART) for HIV/AIDS-patients and their households. We conducted a descriptive study among 1176 HIV/AIDS patients on ART to assess their present status of employment, household poverty and its determinants. About 88% of the patients had stable jobs. Employment rates increased with duration on ART (P=0.033). Overall, poverty rates were 86% of households of HIV-patients ≤1 year on ART while 39% for HIV-patients >1 year on ART (P <0.001). Poverty rates decreased with increasing duration of ART use (P <0.001). ART use decreases poverty among households of HIV/AIDS patients in Nigeria.
Background Although clinical, immunologic, and virologic effects of antiretroviral therapy (ART) for people living with human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) are well-documented, far less is known about the economic benefits of treatment of HIV/AIDS for patients and their households. ART use has been shown to improve work performance, reduce absenteeism and increase employment rates following job loss due to HIV/AIDS. Furthermore, recent longitudinal studies indicated that ART use resulted in a rapid increase in employment and income for patients. The findings of these studies were limited by high attrition rates. Secondly, in low-income countries, ART is started after a substantial drop in the immunity of HIV patients. These studies mainly compared the economic indices of healthy ART-naïve HIV patients with those of immune-depressed patients on ART. Healthy ART-naïve HIV patients are more likely to be employed, maintain productivity, and decrease absenteeism, while ill HV-patients may require some time to become strong enough to work. Thus it is still not clear if these improvements in economic indices from ART and its sustained use in the long-term translate to poverty reduction among HIV/AIDS patients and their households.
Objectives The primary objective of this study was to investigate the rates of employment and poverty among HIV/AIDS patients receiving antiretroviral therapy and their households and to explore the relationships between household poverty and duration of antiretroviral therapy among HIV/AIDS patients in Nigeria.
Methodology A cross-sectional survey was conducted from April to May 2013 with 1,176 HIV/AIDS patients at a large tertiary hospital providing antiretroviral treatment services in South East, Nigeria. Socio-economic and clinical characteristics of the respondents were collected using in-depth interviews with structured questionnaires. Monthly household income was self-reported including all sources of each household member’s income such as salary, wages, pensions, relatives’ supports, interests and revenues. Other characteristics like patient employment status, duration on antiretroviral therapy, adherence to ART, e.t.c. were also obtained. Households earning below the national minimum wage were classified as poor. Also, the economic indices of HIV-patients on ART for one year or less were compared with those of patients who had been on ART for more than one year. Statistical analyses were conducted using Epi Info 3.5.2. Descriptive analyses were presented and multivariable logistic regression analysis was performed to identify independent determinants of household poverty.
Results We interviewed 1176 patients, accounting for 20% of total HIV patients in the study site. Mean age was 35.3 (standard deviation [SD] = 10) years, 71.4% were female, 92.9% had at least a formal education (six years of schooling), 53% were resident in the rural area, and the overall mean duration on ART was 33.2 (SD = 28.2) months. Almost 88% had stable jobs and the mean monthly household income was US$ 156 (SD = 183). The median duration on ART for HIV-patients was significantly associated with the likelihood of being employed (employed (31 months) versus unemployed (19months) using the Kruskal-Wallis test 4.56, P=0.033). Also 624 (53%) were from poor households. Overall 86% of households of HIV-patients who were one year or below on ART were poor, while 39% of households with HIV patients on ART for more than a year were poor (Chi-square 218; P
Conclusion Rates of employment increased and poverty rates decreased with increasing duration of ART among HIV/AIDS patients and their households in Nigeria. Integration of education about sustained use and improved ART adherence counselling, as well as social and financial protection services for HIV-patients belonging to the identified at risk-groups could further reduce poverty among their households and should be implemented. Overall, this study provides evidence that effective delivery of ART services in resource-constrained settings could improve employment rates of HIV patients and reduce poverty among their households. The study findings have important implications for policy. Low-income countries, especially those with high burden of HIV, must further decentralize HIV/AIDS care services to rural and remote communities, for example through integration with primary health care services as an intervention to reduce poverty in people living with HIV/AIDS. Future studies to assess the impact of these interventions are urgently needed in resource-limited settings.