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Two-year impacts on employment and income among adults receiving antiretroviral therapy in Tamil Nadu, India: a cohort study

Thirumurthy, Harshaa,b; Jafri, Aishac,d; Srinivas, Govindarajulue; Arumugam, Viswanathanf; Saravanan, Ramasamy Mf; Angappan, Sathish Kg; Ponnusamy, Manivannang; Raghavan, Subhasreeg; Merson, Michaeld; Kallolikar, Shambhuf

doi: 10.1097/QAD.0b013e328341b928
Epidemiology and Social

Objectives: To estimate the economic impact of antiretroviral therapy (ART) on employment and income of treated patients as well as a comparison group of pre-ART patients who receive care and support in Tamil Nadu, India.

Methods: A cohort of 1238 HIV-infected patients was followed between 2005 and 2007. Socioeconomic data were collected at 6-month intervals. A total of 515 patients initiated ART during the study period, whereas a comparison group of 723 patients were pre-ART. The impact of ART on four employment outcomes was analyzed: participation in economic activities in the past week, number of hours worked in the past week, individual income earned in the past 30 days and 6 months. Regression models including patient fixed effects were estimated. Data from the comparison group of patients were used to adjust for time trends in employment outcomes.

Results: At 6 months after initiation of ART, patients were 10 percentage points more likely to be economically active (P < 0.01) and worked 5.5 additional hours per week (P < 0.01). These increases were over and above those experienced by the comparison group. The estimated 24-month impacts represent a doubling of patients' employment levels at baseline. At 24 months after ART initiation, employment increases remained large and significant. Effects were almost twice as large for men compared with women. Income earned in the past 30 days and 6 months also rose significantly.

Conclusion: ART resulted in a rapid and sustained increase in employment and income for patients. The results demonstrate that ART can improve the economic outcomes of HIV-infected patients.

aDepartment of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

bThe World Bank, Washington, DC, USA

cDepartment of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

dDuke Global Health Institute, Durham, North Carolina, USA

eGerman Leprosy and TB Relief Association-India, India

fTamil Nadu State AIDS Control Society, India

gSolidarity and Action Against The HIV Infection in India, Chennai, India.

Received 2 June, 2010

Revised 12 October, 2010

Accepted 20 October, 2010

Correspondence to Harsha Thirumurthy, PhD, The World Bank and Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA. E-mail:,

© 2011 Lippincott Williams & Wilkins, Inc.