Highly active antiretroviral therapy and employment status in Accra, Ghana

Objectives: This study investigated the immunologic responses and employment history of highly-active antiretroviral therapy (HAART) patients.Design: We interviewed patients and reviewed medical records to collect demographic, clinical, and employ-ment history while on HAART. Demographic charac-teristics were tested as predictors of immunological response while on HAART using hierarchical linear models. Setting: Fevers Unit, Korle-Bu Teaching Hospital, Accra, GhanaParticipants: Subjects comprised a convenience sam-ple of adult HAART patients receiving therapy for at least 9 months. 270 patients were interviewed. 38 were excluded due to inadequate time on HAART or inabil-ity to locate all necessary patient information. Intervention: This was an observational study. Main outcome measures: We investigated the change in CD4 cell count and weight since the initiation of therapy, and their ability to maintain or regain em-ployment as well as the reasons for this. Results: The estimated mean ± standard error increase in CD4 cell count from baseline at 6, 12, and 18 months were 102 ± 5, 204 ± 11, and 236 ± 10 cells/ìL, respectively. Overall, 147 patients (63.4%) reported remaining employed or obtaining new employment while on HAART. Patients who were asymptomatic at initial presentation were more likely to remain em-ployed or returned to work while on HAART than those who were symptomatic (66.4% vs. 48.8%, P = 0.009). Most patients were employed in the informal sector, which made their economic situation particu-larly vulnerable to HIV-associated illness.Conclusion: The findings suggest that patients receiv-ing HAART experience good clinical and immunologi-cal responses as well as improvement in employment status