An instrumental variables evaluation of the effect of antidepressant use on employment among HIV‐infected women using antiretroviral therapy in the United States: 1996–2004

Galárraga, Omar; Salkever, David S.; Cook, Judith Α.; Gange, Stephen J.

doi:10.1002/hec.1458

Cited by 12 publications

(5 citation statements)

References 51 publications

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“…Treatment of depression could lead to better quality of life, an improvement in underlying inflammation, and better outcomes for HIV and other related comorbidities, also affected by depression [38, 39]. Use of antidepressants in women with HIV on antiretroviral therapy was associated with a 29% higher rate of being employed [40]. Nonetheless, Cook et al recently reported that less than half of HIV infected women in WIHS with depressive symptoms actually received appropriate treatment [41].…”

Section: Discussionmentioning

confidence: 99%

Gender-Related Risk Factors Improve Mortality Predictive Ability of VACS Index Among HIV-Infected Women

Cohen

Hotton

Hershow

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Adding gender-related modifiable characteristics or behaviors to the Veterans Aging Cohort Study (VACS) Index might improve the accuracy of predicting mortality among HIV-infected women on treatment. We evaluated the VACS Index in women with HIV, determined whether additional variables would improve mortality prediction, and quantified the potential for improved survival associated with reduction in these additional risk factors. Methods The VACS Index (based on age, CD4 count, HIV-1 RNA, hemoglobin, AST, ALT, platelets, creatinine and Hepatitis C status) was validated in HIV-infected women in the Women’s Interagency HIV Study (WIHS) who initiated antiretroviral therapy (ART) between January 1996 and December 2007. Models were constructed adding race, depression, abuse, smoking, substance use, transactional sex, and comorbidities to determine whether predictability improved. Population attributable fractions were calculated. Results The VACS Index accurately predicted 5-year mortality in 1057 WIHS women with 1 year on HAART with c-index 0.83 (95% CI 0.79–0.87). In multivariate analysis, the VACS Index score (adjusted hazard ratio [aHR] for 5-point increment 1.30; 95% CI 1.25–1.35), depressive symptoms (aHR 1.73; 95% CI 1.17–2.56) and history of transactional sex (aHR 1.93; 95% CI 1.33–1.82) were independent statistically significant predictors of mortality. Conclusions Including depression and transactional sex significantly improved the performance of the VACS Index in predicting mortality among HIV-infected women. Providing treatment for depression and addressing economic and psychosocial instability in HIV infected women would improve health and perhaps point to a broader public health approach to reducing HIV mortality.

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Section: Discussionmentioning

confidence: 99%

Gender-Related Risk Factors Improve Mortality Predictive Ability of VACS Index Among HIV-Infected Women

Cohen

Hotton

Hershow

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Their omission could bias our results since we are not directly controlling for them (Wooldridge 2010, chapter 4). Moreover, there could be reverse causality because PLHIV with low adherence to ART are not likely to achieve adequate CD4 cell count and viral suppression, which in turn will have employment and earnings repercussions (Auld, 2002; Galárraga et al, 2010; Goldman, 2003), which could also affect housing.…”

Section: Methodsmentioning

confidence: 99%

The effect of unstable housing on HIV treatment biomarkers: An instrumental variables approach

Galárraga

Rana

Rahman

et al. 2018

Social Science & Medicine

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Unstable housing, including homelessness, is a public policy concern for all populations, and more critically for people with a serious health condition such as HIV. We measure the effect of unstable housing on HIV treatment biomarkers: viral suppression (viral load < 200 HIV RNA copies per ml) and adequate CD4 T-cell count (CD4>350 cells per μl). We use panel data (1995-2015) from 3082 participants of the Women's Interagency HIV Study (WIHS) sites in Bronx and Brooklyn (NY), Chicago (IL), Los Angeles and San Francisco (CA), and Washington (DC). The instrumental variable (IV) measures allocations for the Housing Opportunities for People with AIDS (HOPWA) per person newly infected with HIV, and it represents actual availability of housing assistance for HIV-positive persons at the metropolitan area level. Using an extended probit model with the IV, we find that unstable housing reduces the likelihood of viral suppression by 51 percentage points, and decreases the probability of having adequate CD4 cell count by 53 percentage points. The endogeneity-corrected results are larger than naïve probits, which show decreases of 8.1 and 7.8 percentage points, respectively. The hypothesized pathways for the effect are: decreased use of mental healthcare/counseling, any healthcare, and less continuity of care. Increasing efforts to improve housing assistance, including HOPWA, and other interventions to make housing more affordable for low-income populations, and HIV-positive populations in particular, may be warranted not only for the benefits of stable housing, but also to improve HIV-related biomarkers.

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“…More specifically, therapeutic advances increased the probability of maintaining employment or finding a new one, although there were still significant differences between the employment rates of the people living with HIV and those of the general population [17]. The existing literature is consistent with respect to the improvements in the employment status of people living with HIV over the past two decades, although, depending on the country and on the period on which the analyses are focused, there are certain variations due to the different progress of the treatments and the different socio-employment conditions in the countries where the analyses were performed [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32].…”

Section: Introductionmentioning

confidence: 70%

The employment situation of people living with HIV: a closer look at the effects of the 2008 economic crisis

2021

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This study aims to assess the determinants of employment probabilities among people living with Human Immunodeficiency Virus (HIV) during a 15-year period (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016) in Spain, focusing on the possible effects of occurrences such as the 2008 economic crisis. The probability of people living with HIV having a job was evaluated by applying several multivariate probit regression models. Differences between the employment status of people living with HIV and that of the general population were evaluated by applying genetic matching regression models. With respect to the former evaluation, for people living with HIV, the period before the crisis (2001)(2002)(2003)(2004)(2005)(2006)(2007) was associated with a probability of being employed that was 2.43 percentage points (p.p.) higher than during the crisis, and the period after the crisis (2014-2016) with a probability that was 7.58 p.p. lower than during the crisis. Greater effects were also observed among males, the probability of being in employment before the economic crisis being higher (by 2.26 p.p.) and lower after the crisis (− 3.41 p.p.) than among women, and among those infected through drug use (6.18 p.p. and − 7.34 p.p. before and after the crisis, respectively), than among those infected through sex. When analysing the differences with respect to the general population, people living with HIV reported lower probabilities of being employed: by − 18 p.p. before the crisis, by − 15 p.p. during the crisis (years 2008-2013) and by − 10 p.p. after the crisis, implying a convergence in the prospects of employment with the passage of the years. Those differences were greater for people of basic educational level (− 23 to − 16 p.p.), a weaker immune system (− 34 p.p. to − 21 p.p.) and those infected through the use of drugs (− 31 p.p. to − 26 p.p.). Although the results suggest that the economic crisis had a greater effect on the employment prospects of people living with HIV, and that effect is still felt by that group, our findings also point towards a convergence of their employment prospects with those of the general population, over the 15-year period assessed. An analysis of the employment situation of people living with HIV might have helped when designing job-seeking methods and policies on the working environment, especially through the 15-year period considered, when the economic crisis had a greater effect on the job market.

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An instrumental variables evaluation of the effect of antidepressant use on employment among HIV‐infected women using antiretroviral therapy in the United States: 1996–2004

Cited by 12 publications

References 51 publications

Gender-Related Risk Factors Improve Mortality Predictive Ability of VACS Index Among HIV-Infected Women

Gender-Related Risk Factors Improve Mortality Predictive Ability of VACS Index Among HIV-Infected Women

The effect of unstable housing on HIV treatment biomarkers: An instrumental variables approach

The employment situation of people living with HIV: a closer look at the effects of the 2008 economic crisis

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