CD4R cell count at antiretroviral therapy initiation and economic restoration in rural Uganda

Atheendar S. Venkataramani, Harsha Thirumurthy, Jessica E. Haberer, Yap Boum Ii, Mark J. Siedner, Annet Kembabazi, Peter W. Hunt, Jeffrey N. Martin, David Bangsberg, Alexander C. Tsai

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objective: To determine whether earlier initiation of antiretroviral therapy (ART) is associated with better economic outcomes. Design: Prospective cohort study of HIV-positive patients on ART in rural Uganda. Methods: Patients initiating ART at a regional referral clinic in Uganda were enrolled in the Uganda AIDS Rural Treatment Outcomes study starting in 2005. Data on labor force participation and asset ownership were collected on a yearly basis, and Cd4+ cell counts were collected at pre-ART baseline. We fitted multivariable regression models to assess whether economic outcomes at baseline and in the 6 years following ART initiation varied by baseline Cd4+ cell count. Results: Five hundred and five individuals, followed up to 6 years, formed the estimation sample. Participants initiating ART at Cd4+ cell count at least 200 cells/ml were 13 percentage points more likely to be working at baseline (P<0.01, 95% confidence interval 0.06-0.21) than those initiating below this threshold. Those in the latter group achieved similar labor force participation rates within 1 year of initiating ART (P<0.01 on the time indicators). Both groups had similar asset scores at baseline and demonstrated similar increases in asset scores over the 6 years of follow-up. Conclusion: ART helps participants initiating therapy at Cd4+ cell count below 200 cells/ml rejoin the labor force, though the findings for participants initiating with higher Cd4+ cell counts suggests that pretreatment declines in labor supply may be prevented altogether with earlier therapy. Baseline similarities in asset scores for those with early and advanced disease suggest that mechanisms other than morbidity may help drive the relationship between HIV infection and economic outcomes.

Original languageEnglish (US)
Pages (from-to)1221-1226
Number of pages6
JournalAIDS
Volume28
Issue number8
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Uganda
Cell Count
Economics
Therapeutics
Ownership
Secondary Prevention
HIV Infections
Acquired Immunodeficiency Syndrome
Cohort Studies
Referral and Consultation
Outcome Assessment (Health Care)
HIV
Prospective Studies
Confidence Intervals
Morbidity

Keywords

  • Antiretroviral therapy
  • Cd4<sup>+</sup> cell count
  • Economic restoration
  • Employment
  • HIV
  • Sub-saharan Africa
  • Uganda
  • Wealth

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases
  • Medicine(all)

Cite this

Venkataramani, A. S., Thirumurthy, H., Haberer, J. E., Ii, Y. B., Siedner, M. J., Kembabazi, A., ... Tsai, A. C. (2014). CD4R cell count at antiretroviral therapy initiation and economic restoration in rural Uganda. AIDS, 28(8), 1221-1226. https://doi.org/10.1097/QAD.0000000000000188

CD4R cell count at antiretroviral therapy initiation and economic restoration in rural Uganda. / Venkataramani, Atheendar S.; Thirumurthy, Harsha; Haberer, Jessica E.; Ii, Yap Boum; Siedner, Mark J.; Kembabazi, Annet; Hunt, Peter W.; Martin, Jeffrey N.; Bangsberg, David; Tsai, Alexander C.

In: AIDS, Vol. 28, No. 8, 2014, p. 1221-1226.

Research output: Contribution to journalArticle

Venkataramani, AS, Thirumurthy, H, Haberer, JE, Ii, YB, Siedner, MJ, Kembabazi, A, Hunt, PW, Martin, JN, Bangsberg, D & Tsai, AC 2014, 'CD4R cell count at antiretroviral therapy initiation and economic restoration in rural Uganda', AIDS, vol. 28, no. 8, pp. 1221-1226. https://doi.org/10.1097/QAD.0000000000000188
Venkataramani AS, Thirumurthy H, Haberer JE, Ii YB, Siedner MJ, Kembabazi A et al. CD4R cell count at antiretroviral therapy initiation and economic restoration in rural Uganda. AIDS. 2014;28(8):1221-1226. https://doi.org/10.1097/QAD.0000000000000188
Venkataramani, Atheendar S. ; Thirumurthy, Harsha ; Haberer, Jessica E. ; Ii, Yap Boum ; Siedner, Mark J. ; Kembabazi, Annet ; Hunt, Peter W. ; Martin, Jeffrey N. ; Bangsberg, David ; Tsai, Alexander C. / CD4R cell count at antiretroviral therapy initiation and economic restoration in rural Uganda. In: AIDS. 2014 ; Vol. 28, No. 8. pp. 1221-1226.
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abstract = "Objective: To determine whether earlier initiation of antiretroviral therapy (ART) is associated with better economic outcomes. Design: Prospective cohort study of HIV-positive patients on ART in rural Uganda. Methods: Patients initiating ART at a regional referral clinic in Uganda were enrolled in the Uganda AIDS Rural Treatment Outcomes study starting in 2005. Data on labor force participation and asset ownership were collected on a yearly basis, and Cd4+ cell counts were collected at pre-ART baseline. We fitted multivariable regression models to assess whether economic outcomes at baseline and in the 6 years following ART initiation varied by baseline Cd4+ cell count. Results: Five hundred and five individuals, followed up to 6 years, formed the estimation sample. Participants initiating ART at Cd4+ cell count at least 200 cells/ml were 13 percentage points more likely to be working at baseline (P<0.01, 95{\%} confidence interval 0.06-0.21) than those initiating below this threshold. Those in the latter group achieved similar labor force participation rates within 1 year of initiating ART (P<0.01 on the time indicators). Both groups had similar asset scores at baseline and demonstrated similar increases in asset scores over the 6 years of follow-up. Conclusion: ART helps participants initiating therapy at Cd4+ cell count below 200 cells/ml rejoin the labor force, though the findings for participants initiating with higher Cd4+ cell counts suggests that pretreatment declines in labor supply may be prevented altogether with earlier therapy. Baseline similarities in asset scores for those with early and advanced disease suggest that mechanisms other than morbidity may help drive the relationship between HIV infection and economic outcomes.",
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AU - Siedner, Mark J.

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