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

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.