Factors associated with improvement in disability-adjusted life years in patients with HIV/AIDS

MORBIDITY AND MORTALITY DUE TO AIDS: A STUDY OF BURDEN OF DISEASE AT A MUNICIPAL LEVEL

Introduction:

The purpose of measuring the burden of disease involves aggregating morbidity and mortality components into a single indicator, the disability-adjusted life year (DALY), to measure how much and how people live and suffer the impact of a disease.

Objective:

To estimate the global burden of disease due to AIDS in a municipality of southern Brazil.

Methods:

An ecological study was conducted in 2009 to examine the incidence and AIDS-related deaths among the population residing in the city of Tubarao, Santa Catarina State, Brazil. Data from the Mortality Information System in the National Health System was used to calculate the years of life lost (YLL) due to premature mortality. The calculation was based on the difference between a standardized life expectancy and age at death, with a discount rate of 3% per year. Data from the Information System for Notifiable Diseases were used to calculate the years lived with disability (YLD). The DALY was estimated by the sum of YLL and YLD. Indicator rates were estimated per 100,000 inhabitants, distributed by age and gender.

Results:

A total of 131 records were examined, and a 572.5 DALYs were estimated, which generated a rate of 593.1 DALYs/100,000 inhabitants. The rate among men amounted to 780.7 DALYs/100,000, whereas among women the rate was 417.1 DALYs/100,000. The most affected age groups were 30-44 years for men and 60-69 years for women.

Conclusion:

The burden of disease due to AIDS in the city of Tubarao was relatively high when considering the global trend. The mortality component accounted for more than 90% of the burden of disease.

Years of potential life lost due to HIV infection and associated factors based on national HIV surveillance data in Latvia, 1991-2010

BACKGROUND

Latvia is still experiencing one of the highest human immunodeficiency virus (HIV) mortality rates in the European Union, and HIV is the 6(th) leading cause of death among young adults (15-39 y) in the country. The aim of the study was to determine the years of potential life lost (YPLL) as an indicator of premature mortality and the associated factors among people living with HIV (PLH) in Latvia.

METHODS

Data from the National Registry of HIV/AIDS Cases was used for the time period 1991-2010. Data on 738 deaths were analysed. The cut-off age for YPLL calculations was 65 y. Univariable analysis was done using Mann-Whitney and Kruskal-Wallis tests. A linear regression model was constructed for determining the independent effects of the particular factors on the number of YPLL.

RESULTS

The total number of YPLL due to HIV in Latvia was 21,097 (50.4/100,000 general population; 511.1/1000 PLH). Each PLH who died had lost 28.8 YPLL on average. The numbers of YPLL reflect the population groups most affected by the HIV epidemic (young men, non-ethnic Latvians, living in the capital city, and being infected via drug injection). Our regression model indicated that among deceased PLH, non-Latvian ethnicity and injecting drug use as the mode of HIV transmission were associated with an additional 2.4 (p = 0.003) and 5.7 (p < 0.001) average YPLL, respectively.

CONCLUSIONS

A considerable number of years of potential life have been lost in Latvia due to HIV. YPLL is significantly associated with ethnicity and mode of HIV transmission.

Do the socioeconomic impacts of antiretroviral therapy vary by gender? A longitudinal study of Kenyan agricultural worker employment outcomes

BACKGROUND

As access to antiretroviral therapy (ART) has grown in Africa, attention has turned to evaluating the socio-economic impacts of ART. One key issue is the extent to which improvements in health resulting from ART allows individuals to return to work and earn income. Improvements in health from ART may also be associated with reduced impaired presenteeism, which is the loss of productivity when an ill or disabled individual attends work but accomplishes less at his or her usual tasks or shifts to other, possibly less valuable, tasks.

METHODS

Longitudinal data for this analysis come from company payroll records for 97 HIV-infected tea estate workers (the index group, 56 women, 41 men) and a comparison group of all workers assigned to the same work teams (n = 2485, 1691 men, 794 women) for a 37-month period covering two years before and one year after initiating ART. We used nearest neighbour matching methods to estimate the impacts of HIV/AIDS and ART on three monthly employment outcomes for tea estate workers in Kenya--days plucking tea, days assigned to non-plucking assignments, and kilograms harvested when plucking.

RESULTS

The female index group worked 30% fewer days plucking tea monthly than the matched female comparison group during the final 9 months pre-ART. They also worked 87% more days on non-plucking assignments. While the monthly gap between the two groups narrowed after beginning ART, the female index group worked 30% fewer days plucking tea and about 100% more days on non-plucking tasks than the comparison group after one year on ART. The male index group was able to maintain a similar pattern of work as their comparison group except during the initial five months on therapy.

CONCLUSION

Significant impaired presenteeism continued to exist among the female index group after one year on ART. Future research needs to explore further the socio-economic implications of HIV-infected female workers on ART being less productive than the general female workforce over sustained periods of time.