INTERNATIONAL STUDIES ON HEALTH AND ECONOMIC DEVELOPMENT- ISHED

THE BOSTON UNIVERSITY-KEMRI-WRP KERICHO COLLABORATION

Beginning in 2001 with support from the U.S. National Institutes of Health through the International Studies in Health and Economic Development grant program (ISHED I), a team from the Boston University Center for International Health and Development, KEMRI Centre for Clinical Research, and the WRP Kericho studied the impact of HIV/AIDS-related morbidity on labor productivity.  The ISHED I study was a retrospective cohort study that compared the amount of tea plucked by 54 tea pluckers who had died of AIDS-related causes or been discharged on medical grounds due to AIDS (index subjects) between 1997 and 2002 during the three years prior to termination of service with that of pluckers who were not known to have died of HIV/AIDS.  Index pluckers were located through records at the company hospital and were matched to a sample of other tea pluckers (reference subjects) who had been working in the same fields on the same days to control for environmental and seasonal factors that affect the amount of tea an individual harvests.
The study documented a statistically significant decrease in work performance and increase in absenteeism over the three-year period preceding a death from AIDS.  The deterioration in on-the-job productivity among index subjects averaged 7.1 kg/day, or 17 percent of the average for the reference subjects, during the last year of service.  During their last year of service, index tea pluckers with HIV/AIDS were absent from work 31 days more than reference tea pluckers and were shifted to less strenuous duties 22 days more often.  The three aspects of productivity loss together resulted in an overall decrease of 35 percent in the quantity of tea produced.  Smaller but statistically significant differences in all three measures were also found in the second-to-last year before death or retirement.

For more information, please see: Fox MP, Rosen S, MacLeod W, Wasunna KM, Bii M, Foglia G, Simon JL. The impact of HIV/AIDS on labour productivity in Kenya. Tropical Medicine and International Health 2004; 9:318-24

Following on the successful completion of the original ISHED I study and the roll out of ART in study region, the Boston University- KEMRI-WRP Kericho team was awarded a second ISHED grant to evaluate the impacts of providing antiretroviral therapy on labor productivity and additional measures of individual and household welfare.

The first ISHED II-funded study is designed as a prospective/retrospective cohort study of HIV-positive workers employed as tea pluckers by two companies in Kericho District who are enrolled in treatment programs funded through the U.S. President’s Emergency Program for AIDS Relief (EP-Kericho).  The study will estimate the effect of treatment on three aspects of labor productivity—impaired performance on the job, absenteeism, shifts to light tasks—and on the household welfare of treated workers.  This study began recruitment in March of 2006 and will continue collecting data through at least 2008. 

A second ISHED II-funded study, which is expected to begin enrollment February or March of 2007, is titled “Economic Outcomes of Antiretroviral Therapy in the Southern Rift Valley Province, Kenya”.  The study is designed as an observational cohort study of HIV-infected adults in the southern Rift Valley Province of Kenya who are registered in HIV/AIDS care and treatment programs in the region, are not on ART at the time of enrollment, have a CD4 count at the time of enrollment is between 350 and 200 mm3, and consent to participate.  For two years following enrollment, two sets of information will be collected for all enrolled subjects: (1) routinely collected clinical data will be extracted from existing clinic records; and (2) individual- and household-related information will be obtained through a structured questionnaire administered to the subject during regularly scheduled visits to the clinic.  Over the two-year period of this study, we expect that the majority of enrolled subjects will become eligible for ART, begin ART, and continue on ART for at least six months.  The primary objectives of this study are to: estimate prevalence of key outcomes such as normal functioning, labor-force participation, and quality-of-life indicators for subjects at the time of enrollment; estimate changes in these outcomes in the months before and after subjects begin ART; document other household impacts of ART, including estimation of the costs associated with seeking care and treatment; and investigate patient- and household-level socioeconomic factors that are associated with these economic outcomes and adherence to ART.