Abstract
This study investigated the relationship between viral load unsuppression and workplace absenteeism among employed adults co-infected with HIV and pulmonary tuberculosis (PTB) in the Govan Mbeki sub-district, South Africa. Despite extensive research on the clinical outcomes of HIV/TB co-infection, there is limited evidence on how these outcomes translate into occupational consequences, particularly absenteeism in working populations.
A quantitative cross-sectional study with retrospective record review was conducted among 286 employed mine workers with confirmed HIV/PTB co-infection and documented unsuppressed viral load levels. Data were sourced from clinical records, laboratory reports, TB treatment files, workplace attendance registers and structured interviews.
The findings revealed a high burden of both poor virological control and workplace absenteeism. Approximately 63.3% of participants had severe viral load unsuppression (≥10,001 copies/mL), while absenteeism was substantial, with a mean of 10 sick-leave days over a three-month period. These results highlight a significant dual burden affecting both health and workforce participation in an economically active population.
However, multivariable analysis did not identify a statistically significant association between viral load category and workplace absenteeism (aOR = 1.205; p = 0.432). The model demonstrated limited explanatory power, suggesting that absenteeism is likely influenced by a broader set of factors beyond virological status alone, including treatment burden, comorbidities, healthcare access and workplace conditions.
These findings highlight the complex relationship between HIV/TB clinical outcomes and functional work capacity. While viral suppression remains a critical clinical goal, improving workplace participation requires integrated interventions that address both health and occupational realities.
The study contributes to a growing body of evidence highlighting the need for holistic, multidisciplinary approaches to HIV/TB management, incorporating clinical care, workplace policies and socioeconomic support systems. Future research should adopt longitudinal designs and include a broader range of clinical, behavioural, and structural determinants to better understand the pathways linking health status and workforce participation.