Interventions for improving employment outcomes for workers with HIV

Cochrane: For people living with HIV(HIV+), losing their job can make it even harder to cope with the illness. This review aimed to assess how we can prevent HIV+ people from losing their jobs or help them return to work. There are three approaches to achieve these aims. The first one is to use drugs, meaning antiretroviral therapy, to keep the disease and its symptoms from getting worse. The second is to make changes to work tasks or the work environment. The third is to offer psychological support to help the HIV+ person cope better with their condition, especially at work.
We included studies that assessed the effects of one or more of these approaches. The effect of interventions can be measured as whether HIV+ persons are employed or not, and as the number of days or hours HIV+ persons were able to work following an intervention.


We found five controlled before-after (CBA) studies from South Africa, India, Uganda, and Kenya and one randomized controlled trial from the USA. The studies included over 48,000 participants. Five studies examined antiretroviral therapy and one study examined vocational interventions as a way of improving return to work in HIV+ people.


The five CBA studies found that antiretroviral therapy interventions may increase employment outcomes in HIV+ people. One study assessed the effect of making changes to work tasks or the work environment but did not report enough data to say if it helped or not. We found no studies on psychological support to help HIV+ people cope better.


Overall, we found very low-quality evidence because the included studies all had a high risk of bias.


We found very low-quality evidence that antiretroviral therapy interventions could improve employment outcomes for HIV+ people. We need high-quality, randomized trials to find out if pharmacological, vocational, and psychological interventions can improve employment outcomes for HIV+ people.

 

Authors' conclusions: 

We found very low-quality evidence showing that ART interventions may improve employment outcomes for HIV+ persons. For vocational interventions, the one included study produced no evidence of an intervention effect. We found no studies that assessed psychological interventions. We need more high-quality, preferably randomized studies to assess the effectiveness of RTW interventions for HIV+ persons.