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

  • Stefano Orlando
Part of the TELe-Health book series (TEHE)



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


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.


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).



Acquired immunodeficiency syndrome




Body mass index


Commission on Social Determinants of Health


Viral load


Disability-adjusted life years


Drug Resource Enhancement against AIDS and Malnutrition


Highly active antiretroviral treatment




Human Development Index


Human immunodeficiency virus


Livestock price survey


Malawian Kwacha


National Aids Commission (Malawi)


National AIDS Control Programme (Malawi)


Gross domestic product


Least developed countries


Purchasing power parity


United Nations


Joint United Nations Programme on HIV/AIDS


United Nations Development Programme


United Nations Population Fund


United Nations Children’s Fund


World Bank


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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