A higher CD4 cell count benefits the household economically
and is associated with better educational opportunities for the children in the
household, according to findings from a study in Uganda
presented last week at the Nineteenth International AIDS Conference in Washington DC.
The findings suggest that earlier diagnosis, and treatment to maintain CD4 cell counts above 350 in order to preserve health, will have economic benefits for households and will allow children to remain in school.
Thirmurthy was reporting on a survey from a community-wide
health campaign in a rural Ugandan parish on behalf of the Gillings School of
Global Health at the University of North Carolina and the SEARCH collaboration.
to ART has dramatically reduced death and disease. More recently the prevention
benefits of starting ART early have been established.
is growing evidence to demonstrate improved socio-economic outcomes among
HIV-positive adults, as well as for their households, after starting ART.
little is understood about the differences in outcomes in this population that
includes both those with high CD4 cell counts and those not enrolled in care.
light of constrained resources understanding these differences and the
potential economic benefits (cost-effectiveness) is necessary to inform policy
debates on resource allocation and ART scale-up/starting ART early.
requires population level data with CD4 cell count information. With this in
mind Dr Thirmurthy and colleagues chose to look at the links between high CD4
cell counts and socio-economic outcomes among adults taking part in a
community-wide health campaign in the rural Ugandan parish of Kakyerere, near
May 2011 they conducted a one-week community health campaign in this community of 6,000 individuals. HIV testing as well other
infectious and non-communicable testing, diagnostic and treatment services were
Community health campaigns,
such as these, serve as a means for widespread HIV testing (see also a
report on a Kenyan community health campaign presented at AIDS 2012). Dr.
Thirmurthy added that these campaigns are an essential part of a
‘test-and-treat’ strategy of the SEARCH collaboration.
The primary objectives were to
data were collected from all participants and a detailed household
socio-economic survey conducted among a random subset.
there were no real differences in occupation distribution (most were farmers)
among HIV-positive and HIV-negative participants, there was a significant
difference in assets. For example, HIV-negative participants owned more land,
had more cows and poultry than those who were HIV-positive.
the 74% (2323) of adults from the community who participated in the campaign
7.8% (179) tested positive, of which close to half were newly diagnosed.
these HIV-positive adults, those with CD4 cell counts greater than 550 cells/mm3
and those with CD4 cell counts between 350 and 550 worked 5.3 and 4.8
more days, respectively in the preceding month than those with CD4 cell counts
under 200 cells/mm3 (p<0.05).
Those with CD4 cell counts equal to
or greater than 500 worked nearly one week more than those with CD4 cell counts
under 200. In addition their employment level was statistically
indistinguishable from those of their HIV-uninfected peers.
were no differences in work patterns between those with CD4 cell counts between
200 and 350 and those with CD4 cell counts under 200, Dr Thimurthy noted.
association between work patterns and CD4 cell counts were similar whether
participants were on ART or not.
Adult health and productivity in
resource-poor settings is known to influence children’s outcomes.
Older children are more likely to be
taken away from school so they can contribute to work on the farm or other
kinds of work to help support the household.
Not surprisingly there was a stronger
association between CD4 cell counts in adults and education among older
children (aged 12-18) than younger children (aged 6-11) because the former are
more likely to be the ones who provide substitute labour for sick adults who
cannot work as much.
addition to improved work patterns older children in households of adults with
CD4 cell counts above 350 cells/mm3 had a 15% higher school
enrolment rate than those in households of adults with CD4 cell counts under
significance, Dr Thimurthy added, the socio-economic outcomes of adults with
CD4 cell counts over 350 were much the same as the HIV-negative adult
Thimurthy concluded these outcomes suggest that starting ART early could well
have immediate as well as long-term economic benefits. Levels of employment and
education would be maintained on a par with their HIV negative peers.
Long-term data and randomised controlled design are
necessary to further establish these benefits, he added.