Interventions for improving employment outcomes for workers with HIV

Area of Science:

• Public Health
• Occupational Health
• Infectious Diseases

Background:

• Unemployment and job loss are significant concerns for working-age adults with human immunodeficiency virus (HIV).
• Returning to work (RTW) after an HIV diagnosis is a complex process, especially after extended absences.
• Previous intervention studies have aimed to improve RTW for individuals living with HIV (HIV+).

Purpose of the Study:

• To evaluate the effectiveness of interventions designed to sustain and improve employment among HIV+ individuals.
• To synthesize evidence from controlled trials and controlled before-after studies on employment interventions for HIV+ workers.

Main Methods:

• A comprehensive literature search was conducted from 1981 to December 2014 across multiple databases.
• Included studies were randomized controlled trials (RCTs) or controlled before-after (CBA) studies.
• Interventions assessed included pharmacological, vocational, and psychological approaches for HIV+ participants aged 16+.

Main Results:

• Six studies (1 RCT, 5 CBAs) were included, assessing vocational training (1 study) and antiretroviral therapy (ART) (5 studies). No studies on psychological interventions were found.
• All included studies had a high risk of bias, resulting in very low-quality evidence.
• ART showed a potential benefit for employment outcomes, with some studies indicating increased work days and likelihood of employment compared to controls or pre-ART status.

Conclusions:

• Very low-quality evidence suggests ART interventions may improve employment outcomes for HIV+ individuals.
• The single vocational intervention study provided no conclusive evidence of effect; no studies assessed psychological interventions.
• High-quality, randomized studies are necessary to reliably assess the effectiveness of RTW interventions for HIV+ persons.