London School of Hygiene & Tropical Medicine

Providing antiretroviral therapy programmes in the workplace can be cost saving for companies in settings with a high prevalence of HIV due to reductions in healthcare costs, absenteeism, and staff turnover according to new research published in PLOS Medicine.

The analysis is the result of a long-standing collaboration with the London School of Hygiene & Tropical Medicine and the Aurum Institute in South Africa.

Every year, more than 2 million people become newly infected with HIV, the virus that causes AIDS, usually by having unprotected sex with an infected partner. HIV can affect individuals in the prime of their working lives, thereby increasing absenteeism and turnover of the workforce as well as the operating costs of companies working in countries where HIV infection is common.

In their study the authors developed a mathematical model to evaluate the past and future impact and costs to the employer of an antiretroviral treatment program provided since 2002 by a coal mining company operating at a number of South African mines. The company, Anglo American, was one of the first to provide services for HIV-infected employees in a poor country, and provided HIV therapy years before it was available in the government sector. By the end of 2010, out of 9,252 employees, 1,149 had tested HIV positive in confirmatory tests and had been enrolled in the company's wellness programme.

The authors' model estimated that, as antiretroviral therapy coverage increased from 10% to 97% of eligible employees, increases in the survival and retention of HIV-positive employees and reductions in absenteeism and benefit payments would lead to overall cost savings compared to not providing antiretroviral treatment. They found the annual cost of HIV to the company would decrease by 5% and the average cost per HIV positive employee would decrease by 14% by 2022.

Although the authors acknowledge some limitations, for example that the analysis did not examine the impact of HIV prevention policies on the miners or their families, and a few model inputs were based on limited data, the changes in costs were robust to a very detailed examination of the uncertainty in the data and translate into average savings of nearly US$1 million per year.

Importantly, they found that even in a country with very low HIV prevalence, antiretroviral therapy would still save companies money compared to not providing treatment. These savings mainly accrue from reductions in benefit payments for death and ill-health retirement and in employee healthcare costs.

Study co-author Alison Grant, Professor of International Health at the London School of Hygiene & Tropical Medicine, said: "Beyond making good business sense, a company-level HIV care programme including ART could go a long way towards improving the strained labour relations in the South African mining sector, especially when improved access to healthcare extends to the entire community. It is crucial that strategies such as those under study here are replicated in other companies in similar settings."

The study was conducted by the London School of Hygiene & Tropical Medicine, Boston University, University of the Witwatersrand, University of Bristol, Anglo American and The Aurum Institute. It was funded by Anglo American and a grant from GlaxoSmithKline to the Aurum Institute.

Publication:

• Meyer-Rath G, Pienaar J, Brink B, van Zyl A, Muirhead D, Grant A, et al. The Impact of Company-Level ART Provision to a Mining Workforce in South Africa: A Cost-Benefit Analysis. PLOS Medicine. DOI:10.1371/journal.pmed.1001869