The Challenge of Sustainability: The Impact of DREAM Programme on the Social, Economic and Working Conditions of Patients with HIV/AIDS

Chapter
Part of the TELe-Health book series (TEHE)

Abstract

Background

This chapter investigates the impact of a DREAM programme on work productivity and household income as important consequences of a public health programme.

Methods

Health status of patients was determined at baseline and subsequent visits through assessment of body mass index, haemoglobin, viral load and CD4 cell subsets. Socio-economic status was assessed exploring productivity (hours worked), income and other economic variables through patient interviews. Using a prospective design, we followed a cohort of patients from the DREAM programme Malawi with the following inclusion criteria: HIV positivity, age >15 and ART initiation within 2 months of enrolment. All subjects had at least 8 months of follow-up post-ART initiation. Health, income and productivity parameters were evaluated through paired t-test.

Results

165 subjects were followed from January 2008 to March 2009. The overall health status of subjects improved significantly based on clinical and virologic parameters (Table 8.1). A positive overall impact on productivity and income was noted with hours worked in the last week increasing by 25%, hours worked in the last month increasing by 31%, income generated in the last week increasing by 85% and income in the last month increasing by 80% (Table 8.2). For patients who were unemployed at baseline (n = 37), mean income was too low (<4$ per month) to be relevant for the analysis. With the exclusion of unemployed patients at baseline, the increase in last week/last month hours worked was +35% and +43%, respectively, and last week/last month income +93% and +89%, respectively (+400$ per year).

Abbreviations

AIDS

Acquired immunodeficiency syndrome

ARV

Antiretroviral

BMI

Body mass index

CSDH

Commission on Social Determinants of Health

VL

Viral load

DALY

Disability-adjusted life years

DREAM

Drug Resource Enhancement against AIDS and Malnutrition

HAART

Highly active antiretroviral treatment

Hb

Haemoglobin

HDI

Human Development Index

HIV

Human immunodeficiency virus

LPS

Livestock price survey

MWK

Malawian Kwacha

NAC

National Aids Commission (Malawi)

NACP

National AIDS Control Programme (Malawi)

GDP

Gross domestic product

LDC

Least developed countries

PPP

Purchasing power parity

UN

United Nations

UNAIDS

Joint United Nations Programme on HIV/AIDS

UNDP

United Nations Development Programme

UNFPA

United Nations Population Fund

UNICEF

United Nations Children’s Fund

WB

World Bank

WHO

World Health Organization

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University Tor VergataRomeItaly

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