title: Economic outcomes of patients receiving antiretroviral therapy for HIV/AIDS in South Africa are sustained through three years on treatment.
abstract: BACKGROUND
  Although the medical outcomes of antiretroviral therapy (ART) for HIV/AIDS are well described, less is known about how ART affects patients' economic activities and quality of life, especially after the first year on ART. We assessed symptom prevalence, general health, ability to perform normal activities, and employment status among adult antiretroviral therapy patients in South Africa over three full years following ART initiation.
  
  
  RESULTS
  A cohort of 855 adult pre-ART patients and patients on ART for <6 months was enrolled and interviewed an average of 4.4 times each during routine clinic visits for up to three years after treatment initiation using an instrument designed for the study. The probability of pain in the previous week fell from 74% before ART initiation to 32% after three years on ART, fatigue from 66% to 12%, nausea from 28% to 4%, and skin problems from 55% to 10%. The probability of not feeling well physically yesterday fell from 46% to 23%. Before starting ART, 39% of subjects reported not being able to perform their normal activities sometime during the previous week; after three years, this proportion fell to 10%. Employment rose from 27% to 42% of the cohort. Improvement in all outcomes was sustained over 3 years and for some outcomes increased in the second and third year.
  
  
  CONCLUSIONS
  Improvements in adult ART patients' symptom prevalence, general health, ability to perform normal activities, and employment status were large and were sustained through the first three years on treatment. These results suggest that some of the positive economic and social externalities anticipated as a result of large-scale treatment provision, such as increases in workforce participation and productivity and the ability of patients to carry on normal lives, may indeed be accruing.
authors.affiliation: Boston University Center for Global Health and Development, Boston, Massachusetts, United States of America. sbrosen@bu.edu
authors.forename: Sydney
authors.initials: S
authors.lastname: Rosen
authors.forename: Bruce
authors.initials: B
authors.lastname: Larson
authors.forename: Alana
authors.initials: A
authors.lastname: Brennan
authors.forename: Lawrence
authors.initials: L
authors.lastname: Long
authors.forename: Matthew
authors.initials: M
authors.lastname: Fox
authors.forename: Constance
authors.initials: C
authors.lastname: Mongwenyana
authors.forename: Mpefe
authors.initials: M
authors.lastname: Ketlhapile
authors.forename: Ian
authors.initials: I
authors.lastname: Sanne
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000191:economics; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics* / Q000276:immunology; D006801:Humans; D008297:Male; D008875:Middle Aged; D013019:South Africa; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents