Test and treat increases access to work and education for people with HIV and their children

An East African study suggests that providing treatment as soon as someone tests HIV-positive improves their work opportunities and household income and their children's education levels.

What is the research about?

Researchers have looked at the social and economic benefits of starting people with HIV on immediate treatment.

This is called ‘test and treat’. The alternative is to start people on treatment when HIV advances to a certain level. But test and treat is better because it enables people with HIV to maintain their health. Because it helps people become virally suppressed it also reduces HIV transmission.

The study was part of the Sustainable East Africa Research in Community Health (SEARCH) trial that ran between 2013 and 2017. In eight communities (intervention communities), people could test for various conditions, including HIV. People diagnosed with HIV got treatment straight away. They also received patient-centred care, such as flexible appointment times and services staffed by welcoming providers. People in eight other communities (control communities) could get stand-alone HIV testing and standard care, which initially linked treatment to HIV level.

Three years after SEARCH finished, researchers surveyed around 8,200 adults and 6,750 children from both types of communities.

Why is this research important?

Making test and treat available to everyone is expensive. So calculating the economic benefits of such a large investment is useful.

What did they find out?

Compared to the control communities, adults with HIV in intervention communities were:

• 10% more likely to have a job
• 10% less likely to seek healthcare
• 13% less likely to spend money on healthcare
• 7% less likely to lose time from their usual activities due to illness.

The benefits of test and treat were most felt by people who had less advanced HIV when they started treatment (measured by CD4 count). Compared to adults in control communities who were in the early stages of HIV when they were first diagnosed, they were:

• 22% more likely to have a job
• 14% less likely to seek healthcare
• 13% less likely to lose time from their usual activities due to illness.

In communities where immediate treatment was available, children who lived with an adult with HIV were more likely to finish primary school and at least some secondary school.

Adults with early-stage HIV who got immediate treatment spent more money on their children's education. This suggests that adults with early-stage HIV who had to wait for treatment were more likely to get ill and miss work, so less likely to be able to afford to educate their children.

What does this mean for HIV services?

Starting HIV treatment immediately after diagnosis has benefits far beyond someone’s health. This study shows that people’s job prospects, how much time and money they spend on healthcare and their children’s education are all at stake.

This evidence can be used to advocate for funding for test-and-treat because it shows that the benefits of such programmes are likely to outweigh the costs. It also shows the heavy price of not providing immediate treatment, both for people with HIV and the wider community.