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HIV treatment and worker absenteeism: Quasi-experimental evidence from a large-scale health program in South Africa

Journal: Journal of Health Economics

Date: 2021

Author: Dominik Jockers, Sarah Langlotz, Declan French, Till Barnighausen

Abstract:
Over the past decade, large-scale HIV antiretroviral therapy (ART) programs have proven hugely successful in improving life expectancy for people living with HIV. However, the extent to which treatment allows patients to maintain a productive work life remains an open question. We apply an instrumental variable method based on individual CD4 counts and exogenously changing treatment guidelines to identify the causal effect size of ART on health-related absenteeism rates among workers living with HIV. We use monthly data from the occupational health program of one of the world’s largest mining companies in South Africa (128,052 observations among 1,924 workers, from 2009 to 2017). Eighteen months after HIV treatment initiation, antiretroviral therapy significantly reduces absenteeism by 1.033 days per worker and month. Using publicly available wage and treatment cost data, we find that the cost savings due to the absenteeism effect of ART alone outweigh treatment costs in the mining sector in several Sub-Saharan African countries.

Link: Google Scholar

Background and Context

Research Setting

Study examines the impact of HIV antiretroviral therapy (ART) on worker absenteeism using data from one of South Africa's largest mining companies between 2009-2017.

Problem

HIV prevalence is around 19% among South Africa's working population, creating significant economic burden through increased absenteeism.

Methodology

Researchers used an instrumental variable approach based on CD4 counts and changing treatment guidelines to identify causal effects of ART on health-related absenteeism.

Reduction in Monthly Absenteeism After ART Treatment

  • Shows increasing effectiveness of ART treatment over time in reducing worker absenteeism
  • Maximum benefit achieved at 18-24 months after treatment initiation
  • Represents significant improvement in worker productivity

Net Cost Benefits of ART Across Different Sectors

  • Negative values represent cost savings (treatment benefits exceed costs)
  • Mining and manufacturing sectors show positive return on investment
  • Agricultural sector shows net costs due to lower wages

Skill Level Impact on ART Effectiveness

  • Lower-skilled workers show higher HIV prevalence rates
  • Treatment effects are stronger for low and semi-skilled workers
  • Demonstrates importance of workplace ART programs for vulnerable worker groups

Cost-Benefit Analysis Across Countries

  • Shows variation in cost-effectiveness across different countries
  • Most countries show positive return on investment in mining sector
  • Differences reflect varying wage levels and healthcare costs

Treatment Impact Timeline

  • Shows spike in absenteeism immediately before treatment initiation
  • Demonstrates gradual improvement after treatment begins
  • Stabilization occurs around 18 months post-treatment

Contribution and Implications

  • Demonstrates substantial economic benefits of workplace ART programs in mining sector
  • Provides evidence supporting universal ART access in workplace settings
  • Shows importance of early treatment initiation for maximizing benefits
  • Highlights potential for public-private partnerships in HIV treatment delivery

Data Sources

  • Treatment effect visualization based on Table 2, Panel B
  • Sector costs visualization based on Table 3
  • Skill level impact visualization based on descriptive statistics in text
  • Country analysis visualization based on Table 3
  • Timeline visualization based on Figure 3 in the article