Early HIV treatment and labour outcomes: A case study of mining workers in South Africa

This study examines whether labour outcomes of HIV-infected workers treated with antiretrovirals depend on the stage of the disease when commencing therapy. We use data on employment separation and absenteeism from the workplace health programme of South Africa's largest coal mining company over the period January 2009 to March 2017 in a Cox proportional hazards model.When treatment was initiated at a CD4+ T cell count above 350 cells/μl, the risk of separating from the company was 36 per cent lower and the risk of absence was 21 per cent lower than initiating at a CD4 count below 200 cells/μl and these differences persist over time. Also, we find that ART initiation at CD4>=350 results in a 11 per cent lower risk of absence prior to treatment.While many companies and the South African government have adopted universal test-and-treat policies aiming to initiate all HIV-infected people as early as possible, most HIV patients still start treatment late in the disease course when their CD4 counts have fallen to low levels. Our results indicate early HIV detection and treatment could have large productivity gains.