title: Expectations about future health and longevity in Kenyan and Ugandan communities receiving a universal test-and-treat intervention in the SEARCH trial.
abstract: Expectations about future health and longevity are important determinants of individuals' decisions to invest in physical and human capital. Few population-level studies have measured subjective expectations and examined how they are affected by scale-up of antiretroviral therapy (ART). We assessed these expectations in communities receiving annual HIV testing and universal ART. Longitudinal data on expectations were collected at baseline and one year later in 16 intervention communities participating in the Sustainable East Africa Research in Community Health (SEARCH) trial of the test and treat strategy in Kenya and Uganda (NCT01864603). A random sample of households with and without an HIV-positive adult was selected after baseline HIV testing. Individuals' expectations about survival to 50, 60, 70, and 80 years of age, as well as future health status and economic well-being, were measured using a Likert scale. Primary outcomes were binary variables indicating participants who reported being very likely or almost certain to survive to advanced ages. Logistic regression analyses were used to examine trends in expectations as well as associations with HIV status and viral load for HIV-positive individuals. Data were obtained from 3126 adults at baseline and 3977 adults in year 1, with 2926 adults participating in both waves. HIV-negative adults were more likely to have favorable expectations about survival to 60 years than HIV-positive adults with detectable viral load (adjusted odds ratio [AOR] 1.87, 95% CI 1.53-2.30), as were HIV-positive adults with undetectable viral load (AOR 1.41, 95% CI 1.13-1.77). Favorable expectations about survival to 60 years were more likely for all groups in year 1 compared to baseline (AOR 1.53, 95% CI 1.31-1.77). These findings are consistent with the hypothesis that universal ART leads to improved population-level expectations about future health and well-being. Future research from the SEARCH trial will help determine whether these changes are causally driven by the provision of universal ART.
authors.affiliation: a Department of Health Policy and Management , Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors.forename: Harsha
authors.initials: H
authors.lastname: Thirumurthy
authors.affiliation: a Department of Health Policy and Management , Gillings School of Global Public Health, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Jakubowski
authors.affiliation: b Department of Obstetrics, Gynecology and Reproductive Sciences , University of California San Francisco , San Francisco , CA , USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Camlin
authors.affiliation: c Makerere University-University of California Research Collaboration , Kampala , Uganda.
authors.forename: Jane
authors.initials: J
authors.lastname: Kabami
authors.affiliation: c Makerere University-University of California Research Collaboration , Kampala , Uganda.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Ssemmondo
authors.affiliation: d Kenya Medical Research Institute , Nairobi , Kenya.
authors.forename: Assurah
authors.initials: A
authors.lastname: Elly
authors.affiliation: e The Palladium Group , Nairobi , Kenya.
authors.forename: Daniel
authors.initials: D
authors.lastname: Mwai
authors.affiliation: f Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco , San Francisco, CA , USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Clark
authors.affiliation: b Department of Obstetrics, Gynecology and Reproductive Sciences , University of California San Francisco , San Francisco , CA , USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Cohen
authors.affiliation: d Kenya Medical Research Institute , Nairobi , Kenya.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bukusi
authors.affiliation: g Department of Medicine, School of Medicine, Makerere University College of Health Sciences , Kampala , Uganda.
authors.forename: Moses
authors.initials: M
authors.lastname: Kamya
authors.affiliation: h University of California Berkeley School of Public Health , Berkeley, CA , USA.
authors.forename: Maya
authors.initials: M
authors.lastname: Petersen
authors.affiliation: f Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco , San Francisco, CA , USA.
authors.forename: Diane
authors.initials: D
authors.lastname: Havlir
authors.affiliation: i Department of Medicine and Center for AIDS Prevention Studies, University of California San Francisco , San Francisco, CA , USA.
authors.forename: Edwin D
authors.initials: ED
authors.lastname: Charlebois
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D044383:Black People / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006679:HIV Seropositivity; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008136:Longevity; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: Antiretroviral therapy; health expectations; subjective life expectancy; test and treat