HIV Disease Severity and Employment Outcomes in Affected Households in Zambia

The relationship between immune status and employment outcomes in HIV-infected patients on long-term antiretroviral therapy (ART) in sub-Saharan Africa and their HIV-affected households is not well understood. We assessed the relationship between CD4+ T-cell counts of ART-treated adults at public-sector clinics in Lusaka, Zambia (median treatment duration 973 days) and labour force participation in the HIV-affected households using clinical and survey data. In multivariable models, patients with a CD4+ count >350 cells/µl were 22 percentage points more likely to be engaged in labour (95% CI: 0.02, 0.42) and worked approximately 6 more days per month compared to patients with a CD4+ count <350 cells/µl. A similar relationship between patient CD4+ count and labour participation was observed for other adult family members in the HIV-affected household, but it was not statistically significant. These findings suggest interventions that promote and maintain robust immune recovery on ART may confer economic benefits.