LIWA - Living With Antiretrovirals

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In regions heavily affected, the HIV epidemic had a huge impact at the individual, families, society and health care levels. Since October 2005, access to antiretroviral treatments has been incorporated under the universal health coverage system in Thailand transforming the disease from a fatal to a chronic disease. The LIWA project was primarily designed to investigate the impact of antiretroviral treatments on the lives of the HIV-infected adults and more broadly of their families and their communities. The study comprises two quantitative life-event history surveys: one of persons living with HIV/AIDS (Cases) receiving antiretroviral treatment (completed in November 2007); and the second conducted in the autumn of 2008 on a sample of the general population (controls), matched on the village of residence, sex and age of the previously interviewed HIV-infected respondents

Results
513 patients and 500 controls were interviewed.
​A gender-based analysis indicates that women have more and earlier access to HIV testing and ARV treatment than men (Le Coeur S et al. Soc Sci & Med, 2009, 69 (6): 846–853).

• We also analyzed the intergenerational relationships of HIV-infected patients. The regained health allows them to work, take care of their family and fulfill their filial duties as expected in the Thai society (Lelièvre E, et al. Ageing & Society. May 2011, pp 1-25)
• Despite fear of stigmatization, the study indicates a high rate of disclosure of HIV status to partners and relatives (CEPED Working Paper n°16, Sept 2011. CEPED)

Economic Report

One of the first studies on cost effectiveness of antiretroviral therapy in Thailand, by the World Bank published in 2004, compared the cost effectiveness of government provision of free first line antiretroviral treatment only compared to first and second treatment.  The report recommended that provision of first line treatment while questioning the cost-effectiveness of including second line treatment. In July 2007, the authors reassessed their estimations, under a new assumption of a 90% decrease in the second line drug prices and concluded that provision of first and second line treatments was cost-effective and sustainable for Thailand. 

However, this modelling was based on a population model and efficacy data derived mostly from the literature on cohorts from non-Thai settings.  In addition, there has been major changes in price of antiretrovirals, since the Thai Government has made available generic second line drugs at a much lower price. The study aims to conduct a cost effectiveness analysis of first line compared to first and second line treatments based on primary data on the actual costs and efficacy within a cohort of adults receiving antiretroviral therapy as part of the PHPT-Oxfam Treatment program in community hospitals in Northern Thailand. The study will also incorporate quality of life assessments to allow for cost-utility analysis in terms of quality life years saved.