Background: Little is known about the impact of HIV on the work and home productivity of HIV-positive individuals in sub-Saharan Africa. Most existing evidence originates from individuals employed in the formal sector and at specific disease stages, which are not representative of the general working population. This study compared the number of work days lost to illness or accessing health care for HIV-positive and HIV-negative individuals in South Africa and Zambia.
Methods: As part of the HPTN 071 (PopART) study, data from approximately 2000 randomly selected adults aged 18-44 years were gathered between November 28, 2013, and March 31, 2015, from each of 21 communities in Zambia and South Africa. Information on the number of productive days lost in the last 3 months, laboratory-confirmed HIV status, labour force status, age, ethnicity, education, and recreational drug use was collected. Differences in productive days lost between HIV-negative and HIV-positive individuals at various lengths of time on treatment were estimated with negative binomial models. Results are presented in differences in productive days lost.
Results: From data for 19,750 respondents in Zambia and 18,941 respondents in South Africa, HIV prevalence was 21.0% (Zambia) and 22.2% (South Africa). HIV-positive individuals lost more productive days to illness than HIV-negative individuals in both countries. Excess productive days lost by HIV-positive individuals in a 3-month period were 0.74 (95%CI:0.48-1.01;p< 0.001) in Zambia and 0.13 (95%CI:0.04-0.23;p=0.007) in South Africa compared to HIV-negative individuals. Results for excess days lost disaggregated by ART status were as follows:

 ZambiaSouth Africa
HIV-positive individuals not on treatment0.61 (95%CI:0.30-0.92,p<0.001)0.03 (95%CI:-0.05-0.11,p=0.416)
HIV-positive individuals on treatment for less than one year1.24 (95%CI:0.34-2.14,p=0.007)1.41 (95%CI:-0.004-2.82,p=0.051)
HIV-positive individuals on treatment for one to two years1.08 (95%CI:0.06-2.11,p=0.038)0.18 (95%CI:-0.19-0.54,p=0.341)
HIV-positive individuals on treatment three years or more0.79 (95%CI:0.16-1.41,p=0.014)0.001 (95%CI:-0.13-0.14,p=0.961)
[Excess days lost disaggregated by ART status]

Conclusions: There is a significant burden in lost work and home productivity due to HIV in the general population, but it is smaller than existing estimates for samples dominated by formal sector workers. Productive days lost need to be considered when evaluating the benefit of HIV prevention from a societal perspective. The findings will support policy makers in building an investment case for HIV interventions.

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