Improvement in Socio-Economic Productivity of HIV Positive Individuals on Antiretroviral Treatment in a Private Setting in South India

PLHIV have decreased economic productivity both due to direct and indirect causes.Data from developed countries have shown that at the societal level, high costs ART are offset by increased productivity.We hypothesized that post-ART the SES would improve regardless of the baseline SES and will be sustained over time.Our objective was to perform a comprehensive SES evaluation pre/post ART initiation using an ambispective cohort study design.We used Indian household-specific SES validated tool, with score of <15 being indigent to >76 being affluent, along with clinical, ART adherence data at median of 6 and 18 months post ART, and compared using paired t-tests.Among 140 persons started on ART, with a median follow up of 22 months, 118 had Pre-ART SES data, of these: 57% were women; median age was 38 years; 67% were married; 89 (78%) had heterosexual sex as HIV risk; 40 (34%) had major OI and/or TB at presentation.Reported self-occupation was: skilled labourers 41 (35%); 12 (10%) unskilled labourers; 27 (23%) housewives; 26 (22%) professionals/blue collar job; 1 student, 10 unemployed.The median pre-post ART CD4 cell counts were: 187 and 454 cells/cumm (P < 0.01); median body weight pre-post ART was 54 and 57 kg (P < 0.01); 97% of the participants were 100% adherent.The mean Pre-ART total SES score was 37.06 (+/-10.2);and Post-ART SES score 40.62 (+10.1 P < 0.001) and these results were sustained over time and remained significant even when only monthly income was considered.Our data show a significant impact of ART on SES in a sustained manner in a developing world setting, which has policy level implications.