Work productivity effects of HIV prevention and treatment interventions on populations from endemic settings

Understanding the economic potential of HIV prevention and treatment interventions (HIVPTI) is key for policy makers to allocate scarce health care resources most efficiently. With HIV a barrier to sustainable development, HIVPTI have potential to improve individual economic productivity by reducing lost healthy days and enabling individuals in their economic productivity. However, there is limited evidence on the economic potential of HIVPTI. The research project will focus on South Africa where about 20 per cent of the global HIV population lives and where consequentially economic potential due to HIVPTI is largest.
The research will combine methodologies from infectious disease modelling and health economic impact and cost-effectiveness analysis to understand the long-term effects of HIVPTI on economic development. I will analyse the effect of HIVPTI on work productivity effects, e.g. sickness absence, days lost to accessing health care and presenteeism, and simulate the long-term economic effects on the individual and on the country-level. The developed analytical approach will also be useful for future studies aiming at understanding the economic potential of prevention and treatment of other infectious diseases in other contexts. I will combine three unique studies for the analysis: The HPTN 071 (PopART) trial, a HIVPTI trial in South Africa and Zambia; The National Income Dynamics Study (NIDS); and the Demographic Health Survey (DHS) South Africa are representative studies of the South African population.
I will work with Dr Hauck from Imperial College who is the leading health economist on the PopART trial. I will integrate health economic analysis in infectious disease modelling working together with Prof. Fraser, lead of the Pathogen Dynamics Group at the University of Oxford and lead modeller of the PopART trial, and Dr Cori, an expert in modelling of infectious diseases at Imperial College who has helped to develop the PopART model. Prof. Meyer-Rath, who is a leading epidemiologist on the economics and cost-effectiveness of HIV interventions in South Africa, will collaborate with me on the estimation of country wide effects and translation of findings into policy. Dr Fichera, head of the department of economics at the University of Bath, will contribute to the development and productivity analysis of HIVPTI. I will collaborate with Dr Anselmi from the University of Manchester who is an expert in big data on the setup and analysis of the three large datasets. Prof. Sutton, lead of HOPE at the University of Manchester, will act as advisor.

HIV is a threat to sustainable development and top of the global health research agenda. My research will focus on South Africa which has the largest HIV epidemic in the world and where HIV accounted for about 50% of all life years lost due to illness in 2010. As a major contributor to the burden of disease and for being concentrated in the working age population, HIV comes at large socio-economic cost. Understanding work productivity effects of HIV prevention and treatment interventions (HIVPTI) is thus important for policy makers in their decision to allocate scarce resources most effectively.
The impact of HIVPTI on HIV and work productivity can work along several pathways: Healthier individuals are more effective in producing and delivering goods and services both in households and at the workplace. This has social and economic returns, in the form of monetary and wider societal value added. Moreover, as health can be considered an investment good, the prospect of prolonged life lived in better health leads to higher monetary returns of investments into education, hence incentivising individuals to invest in human capital with positive social and economic returns in the long-term.
However, the exact consequences of HIVPTI on work productivity and long-term economic development are unknown. Existing evidence on Anti-Retroviral Therapy (ART) effects on work productivity is promising and shows positive correlations of ARTs with economic activities however limited to small-scale observations of unrepresentative sub-population groups. These findings cannot answer the essential questions of productivity effects in the long-term considering HIV-dynamics. Neither provide these studies any basis for generalising findings to the wider public which is the important piece of information required by policy makers deciding on allocating scarce resources in health. My research project will address these gaps in the literature.

My research has three levels of impact:

(1) Internal impact (impact with Imperial College, the MRC Centre):

My research will stimulate the intellectual research environment, debate and development of combining health economic methods with epidemiological methodologies within the MRC Centre. I will add health economic knowledge to the centre. Driven by my strong interest to gain knowledge in epidemiological research, I will be able to bridge between the two disciplines. This will enable me to identify research synergies of both disciplines for current and future projects.
The focus of my project strongly contributes to the interests of the MRC Centre in long-standing inter-disciplinary research in HIV research and making a difference to PLHIV through translating research findings into policy effects. More precisely, my research will contribute to the ongoing investigation of the PopART trial. Findings of my study can then help in investigating the wider economic impacts of various scenarios of roll out of interventions.

(2) External impact (Impact outside of Imperial College):

My research project will inform policy makers on the wider benefits of HIV policies that go beyond health gains. Adding the wider economic effects will potentially substantially change the cost-effectiveness of HIV Interventions. The methodological approach of integrated infectious disease modelling into health economic impact analysis can be expanded to other settings (countries) and infectious diseases and stimulate debate about the investment case into treatment of such diseases. The methodological developments will be very significant for academic research that aims at understanding the spread of disease in populations, the effect of prevention and intervention programmes, and the economic benefits of such interventions. This research encompasses several areas, such as health economics, development economics, public health, epidemiology and infectious disease modelling. My work will also contribute to the strategic global health focus of the MRC of providing evidence for policy-makers and strengthen portfolio of research into HIV/AIDS.

(3) Personal impact:

The research will enable me to achieve the objectives of the project. By the end of the research, I will have become an independent researcher with a strong network of academics and policy experts and with the skill set required to make contribution to both academia and policy in the long-term. The MRC SDF will enable me to become one of the few health economists nationally and internationally with strong quantitative skills in both health economics and infectious disease modelling.