Abstract Body

Improvements in community health due to multi-disease health services and universal antiretroviral treatment have the potential to improve various socio-economic indicators, thereby informing cost-benefit calculations for such investments in healthcare.

We conducted longitudinal socio-economic surveys over a 3-year period in households of approximately 100 HIV-infected and 100 HIV-uninfected adults sampled after baseline HIV testing in 30 pair-matched communities in the SEARCH trial (NCT01864603). Control communities received baseline multi-disease testing and antiretroviral therapy by national guidelines while intervention communities received annual testing and antiretroviral therapy irrespective of CD4 count via patient-centered care. Surveys assessed various outcomes including employment, consumption expenditures, asset holdings, survival expectations, and children’s school enrollment. The primary outcome was employment hours in the past week for individuals aged 18-65 years. Regression models with individual fixed effects and time trends were used to determine causal effects of the SEARCH intervention. Effects were examined for subgroups of HIV-positive adults with CD4 cell counts ≥500 and <500 cells/mm3, their HIV-negative household members, and HIV-negative individuals in households without an HIV-positive adult.

Longitudinal data were collected for 34,396 individuals from 5,283 households. Adults worked an average of 29.6 hours and the majority of employment occurred on households’ own farms. Total employment hours among all adults did not change significantly due to the SEARCH intervention but among baseline HIV-positive adults, the intervention increased employment by 6.1 hours (p<0.001). Effects were largest among HIV-positive adults with baseline CD4≥500 (increase of 9.9 hours, p<0.01). Children in households with an HIV-positive adult were 5.3 percentage points more likely to complete primary school due to the SEARCH intervention (p<0.001). Outcomes such as assets, non-food expenditures, and survival expectations improved significantly over time, but there were no significant differences between intervention and control communities.

Universal antiretroviral therapy provision led to significant economic benefits for HIV-positive adults, particularly those with high CD4 counts. Improvements in socio-economic outcomes and survival expectations were observed in all communities following multi-disease testing at baseline.