Fehmida Visnegarwala, MD, MPH 1,2, Anuradha Nalli 1, Ram Babu 1, Saranya Satish 1, Lekha Pradeep 1, Glory Alexander 1 1 ASHA Foundation, Bangalore, & 2.

Fehmida Visnegarwala, MD, MPH 1,2,

Anuradha Nalli1, Ram Babu1, Saranya

Satish1, Lekha Pradeep1, Glory

Alexander1 1 ASHA Foundation, Bangalore, & 2

Institute of Health Management Research, (IHMR)-

Bangalore

[email protected]

Impact of Anti-retroviral Therapy (ART) on Socio-Economic (SES) productivity of HIV infected individuals in an Urban Indian Private Setting

A-452-0401-11145MOPDE02

Presented at XIX International AIDS Conference 22-27 July 2012 | Washington D.C., USA

Background and MethodsHIV/AIDS, leads to impoverishment due to both direct/indirect costs of illness. In countries such as India, the maximum socioeconomic impact due to HIV/AIDS is felt only at the household levels. The use ART has translated into substantial cost-effectiveness at the societal level, but the overall impact of ART on productivity of households of PLWHA are limited.

Thus we sought to evaluate the effect of ART on an urban sample of Indian households, with particular emphasis on individual and household productivity, acquisition of fixed and liquid assets, and overall socioeconomic status using a comprehensive assessment tool. This tool is a well-validated tool to assess SES in the Indian setting. 1

Since 2007, ASHA Foundation, (a NGO in Bangalore , India) has implemented the above SES assessment tool for evaluation of free-ART eligibility under PPP model. This tool was filled by trained social-workers during a face-to-face interview with the patient, before ART initiation at ASHA foundation.

Description of the Tool:

There are a total of 22 questions, which assess monthly household: income; educational status of parents and children and societal and professional positions held; occupation; number of earning members; the kind of dwelling; number of children; family Possessions, i.e., urban, agricultural or non-agricultural land and animal stock; type and locality of residence; income tax paid; caste; deployment of domestic help among other things. The highest score attainable is 100 and lowest score is 5. The social status is then divided into 6 strata based on total score as lower, middle and upper class.

1 : Agarwal OP , J of Community Medicine 2005 Abstract number: 111452

Study Design and Statistical Analysis

Fehmida Visnegarwala, Abstract number: 11145 3

The SES status, demographic, clinical and adherence data were collected in both retrospective and prospective manner.

The study was approved by the ethical review board, and data in the prospective study was collected after obtaining written informed consent. All measures to preserve the confidentiality of subject identifiers were taken.

Sample Size Calculation Our objective was to evaluate the mean change in SES scores. Thus to detect a mean delta in SES scores of 2.5 pre and post ART; with 80% power and a 2-sided alpha of 0.05 with a paired sample t-test, a sample size of 69 was required. We followed a cohort of 136 patients.Statistical Analysis Descriptive statistics were used to analyze the frequency of data. The pre and post scores were compared using “paired t-tests. Correlation coefficients were done as well. Univariate regression analysis was done to evaluate factors predictive of highest quartile increase in SES score. Those factors significant at 0.2 level of less were placed in multivariate analysis. All study data was transcribed in a Excel Database and analyzed by SAS.

Retrospective Data on Baseline

SES Questionnaire

filled in 2007 or Earlier

HAART Initiation

Prospective Follow up SES scoring done

using the same tool at 6 and 18

months after ART

An ambi-spective (both retro and prospective) cohort study design

Results-I

Baseline Median 6-12 months

>18 months0tan28a566028

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Change in Total SES score and Monthly Income

Total SES scoreMonthly Income

P < 0.001P < 0.001

P < 0.001

P < 0.001

At the end of two years 136 patients had continuous follow-up. The median follow up of both the retrospective and prospective components of the cohort was 58 months.

From highest score change of + 27 to – 9 was recorded . Overall the median change in score was +3 which was significant . Overall 115 patients had an increase in the Total SES score. The change in monthly income score also was significant. The change was sustained over 18 months

Results-II

5

High Class >61 Middle Class >31 Poor Class >15

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Changes in the socio-economicproductivity by SES class (Pre and

Post ART)

Before ART After ART

P<0.001

Fehmida Visnegarwala, Abstract number: 11145 6

Results-III

Before ART After ART

165.7

497

Change in CD4 cell counts

(Cumm) pre and post ART

Before ART

After ART

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Change in Weight (kg) pre and post

ARTP < 0.0001

Correlation between Change in CD4 and

Change SES r = 0.17579

with P = 0.043

Correlation between Change

in Weight and Change in SES r

= 0.22 with P = 0.0098

The univariate analysis of factors predicting highest quartile change in SES scores: change in CD4 , change in weight was positively associated while being a housewife was negatively associated. On multivariate analysis, only being a housewife (0.02-0.94 95% CI; p<0.05) remained significant.

Discussion and ConclusionOverall > 95% of our patient cohort had 100% adherence to ART

Use of ART is associated with significant improvement in the overall household incomes of PLWHA regardless of the costs incurred for HIV Care

This change in SES status is associated with increase in CD4 and increase in body weight suggesting that improvement in clinical parameters with ART are associated with better economic productivity.

This prospective cohort study showed , that this improvement in income appears to be sustained even after more than 18 months of ART, this to our knowledge is the longest median duration of f/u after ART initiation.

Not surprisingly, being a housewife was independently associated with non-improvement in the SES scores.

Our Data are consistent with other studies from Africa which show a significant improvement of SES, and thus the overall quality of life with the use of ART, which can be used to increase the overall uptake of ART and its adherence in the developing countries.

Overall these data have significant policy implications in scaling up of ART in the national and global perspective especially when we can bring this bend to fight the stigma and discrimination for ART take up.

Thank you

8

[email protected]