Recent Publications

Early effects of antiretroviral therapy on work performance: preliminary results from a cohort study of Kenyan agricultural workers

Abstract  Objective: This paper estimates the impact of antiretroviral therapy (ART) on days harvesting tea per month for tea-estate workers in Kenya. Such information is needed to assess the potential economic benefits of providing treatment to working adults. Methods: Data for this analysis come from company payroll records for 59 HIV-infected workers and a comparison group of all workers assigned to the same work teams (reference group, n = 1992) for a period covering 2 years before and 1 

Private Sector Provision and Financing of AIDS Treatment in Africa: Current Developments

Abstract Despite the rapid expansion of public sector highly active antiretroviral (ARV) treatment programs, the private sector continues to be an important source of services and financing for AIDS treatment in Africa. This article reviews currently available information on private sector initiatives, including recent innovations. Private sector providers continue to offer ARV treatment, although adherence problems resulting from high user fees indicate the need for employer, donor, or 

Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review

Abstract Background: Long-term retention of patients in Africa's rapidly expanding antiretroviral therapy (ART) programs for HIV/AIDS is essential for these programs' success but has received relatively little attention. In this paper we present a systematic review of patient retention in ART programs in sub-Saharan Africa. Methods and Findings: We searched Medline, other literature databases, conference abstracts, publications archives, and the “gray literature” (project reports available 

Cost to patients of obtaining treatment for HIV/AIDS in South Africa

Abstract Background: South Africa is providing antiretroviral (ARV) drugs for HIV/AIDS free of charge in order to increase access for poorer patients and promote adherence. However, non-drug costs of obtaining treatment may limit access. We estimated the costs that South African patients incur in obtaining antiretroviral therapy (ART). Methods: A random sample of adult pre-ART and ART patients attending a public urban hospital (site 1), a peri-urban (informal settlement) non-governmental 

The impact of AIDS on government service delivery: the case of the Zambia Wildlife Authority

Abstract The loss of working-aged adults to HIV/AIDS has been shown to increase the costs of labor to the private sector in Africa. There is little corresponding evidence for the public sector. This study evaluated the impact of AIDS on the capacity of a government agency, the Zambia Wildlife Authority (ZAWA), to patrol Zambia’s national parks. Methods: Data were collected from ZAWA on workforce characteristics, recent mortality, costs, and the number of days spent on patrol between 2003 and 

The private sector and HIV/AIDS in Africa: taking stock of six years of applied research

Abstract Background: Until recently, little was known about the costs of the HIV/AIDS epidemic to businesses in Africa or about business responses to the epidemic. This paper synthesizes the results of a set of studies conducted between 1999 and 2006. Methods: Data for the studies included were drawn from human resource, financial, and medical records of 16 large companies and from 7 surveys of small, medium-sized, and large companies in South Africa, Uganda, Kenya, Zambia, Ethiopia, and 

Prevalence of HIV infection and median CD4 counts among health care workers in South Africa

Abstract Objective: To determine the prevalence of HIV infection and the extent of disease progression based on CD4 count in a public health system workforce in southern Africa. Design: Cross-sectional voluntary, anonymous, unlinked survey including an oral fluid or blood sample and a brief demographic questionnaire. Setting: Two public hospitals in Gauteng, South Africa. Subjects: All 2 032 professional and support staff employed by the two hospitals. Outcome Measures: HIV prevalence and CD4 

Treatment for HIV/AIDS at South Africa’s largest employers: myth and reality

Abstract Objectives: To determine what proportion of employees at the largest private-sector companies in South Africa have access to HIV/AIDS care and treatment, including antiretroviral therapy (ART); how many employees are enrolled in disease management programmes; how many are receiving ART; and which approach to the financing and delivery of care is proving most successful at reaching eligible employees. Design: All 64 private-sector and parastatal companies with more than 6000 employees 

Will small and medium enterprises provide HIV/AIDS services to employees? An analysis of market demand

Abstract Background: Although many large businesses have begun offering HIV/AIDS prevention and treatment services to employees, the vast majority of small and medium sized enterprises (SMEs) have not. SMEs face constraints reducing their demand for services. This study identifies and evaluates those constraints to determine the extent to which SMEs can be expected to implement HIV/AIDS programmes, and to identify opportunities for strengthening the role of SMEs in South Africa’s response to 

Hard choices: rationing antiretroviral therapy for HIV/AIDS in Africa

Abstract In the past three years, expanding access to antiretroviral therapy (ART) for HIV/AIDS has become a global objective and a national priority for many countries in sub-Saharan Africa. Large-scale treatment programs have been launched in countries spanning the continent from Lesotho to Ghana, paid for by domestic funds mobilized by African governments and by international donor contributions. While these funds, which reach into the billions of dollars, will pay for ART for many 

Provision of antiretroviral therapy by the private sector

Abstract The assessment by Lester Venter (Apr 2, p 1215) of the extent to which the private sector is filling the need for antiretroviral treatment (ART) for HIV/AIDS is misleading. Public announcements by a few large private companies about the scale of their HIV/AIDS programmes should be interpreted cautiously. Few companies have made public what proportion of employees are eligible for the programmes, what proportion are in need of treatment, or how many are actually receiving it. We 

The impact of HIV/AIDS on labour productivity in Kenya

Abstract Objectives: To estimate the impact of HIV/AIDS on individual labour productivity during disease progression. Methods: We used a retrospective cohort design to study the productivity and attendance of tea estate workers who died or were medically retired because of AIDS-related causes between 1997 and 2002 in western Kenya. We compared daily output in kilograms of tea leaves plucked, use of paid and unpaid leave and assignment to less strenuous tasks by 54 workers who died or were