Productivity among workers in the private sector who receive antiretroviral therapy through employee health schemes may not always return to pre-illness levels, according to findings from Kenya. Jonathan Simon of Boston University told the HIV Implementers’ Meeting in Kigali, Rwanda, that companies may have to look at earlier initiation of treatment if they want to see workers return to full productivity.
Dr Simon was reporting results from a study of ART response among employees on a tea plantation in the Kericho district of Kenya, where tea companies began providing antiretroviral treatment with PEPFAR assistance in 2004.
The study looked at four specific measures of productivity in a group of HIV-positive workers who began antiretroviral therapy between April 2004 and September 2005. They were compared with 2,079 HIV-negative reference cases in the workforce, using company pay roll and medical records. The analysis excluded HIV-positive tea pickers who died in the first twelve months after starting treatment.
The study analysed a number of easily quantifiable measures: the number of days spent plucking tea per month; the average number of kilos of tea plucked per day; the number of days spent on light duties due to illness, and the amount earned per month.
The average age of the HIV-positive index patients was 40 years and the majority were women.
Because pay roll and medical records were available for the 24-month period prior to starting treatment, the researchers were able to demonstrate that productivity in the HIV-positive index cases began to decline at least nine months before treatment was started. On average they worked 4.3 days (23%) less than their HIV-negative counterparts each month, amounting to some loss of income, since tea pickers are paid by weight of tea picked. However, tea pickers received sick pay at the estates studied.
After treatment began, the number of days spent picking tea increased rapidly, as did the volume of tea picked.
However, the volume picked by HIV-positive people on treatment never matched the volume achieved by the HIV-negative reference workforce on the days that they worked. After one year on treatment, HIV-positive tea pickers were picking 16% less tea per day worked, and still spent 10% fewer days plucking tea.
They spent twice as much time doing `light’ duties such as sweeping up during the first six months on treatment when compared with reference cases, but this difference began to disappear between months seven and twelve of treatment.
During the first six months of treatment their earnings averaged 75% of the average earnings of the reference group. Their earnings grew to 89% of the earnings achieved by the reference group during months 7-12.
Presenter Jonathan Simon, who works in Boston University’s Center for International Health and Development, said: “What are the implications of long-term lower performance for the company, and its ability to sustain treatment without PEPFAR funding?”
“If we want the private sector to assume the costs we will have to deal with some of these questions of productivity on treatment.”
Professor Charles Gilks of the World Health Organization said: “I think it confirms that from a productivity point of view we’re starting people too late.”
Many larger employees in Africa have begun to provide antiretroviral treatment to elements of their workforce. All have made calculations about the effects of treatment provision on productivity. Whether the findings of a study in agricultural labourers will be applicable to workers in other industries is debatable, and further studies in other industries, looking at different grades of workers and different criteria for treatment initiation are urgently needed in order to help companies plan the extent to which they can provide treatment through company health schemes.
Simon J et al. Early effects of antiretroviral therapy on work performance: results from a cohort study of Kenyan agricultural workers. HIV Implementers’ Meeting, Kigali, Rwanda, abstract 811, 2007.