A package of care for HIV in the occupational setting in Africa: results of a pilot intervention

We describe a package of care including prevention, education, and therapeutics for human immunodeficiency virus (HIV) infection in the occupational setting in sub-Saharan Africa and evaluate the outcomes of this package over 1 year. A prospective cohort study was done between 1999 and 2000 in a sugar mill employing 386 men in Kwa-Zulu Natal in South Africa. A package of care for HIV in the occupational setting was developed and implemented in 1999. This response included prevention, education, and therapeutic components. Outcomes measured included condoms distributed, sexually transmitted infections treated, numbers of HIV-infected individuals entering into the therapeutic pathway developed, and numbers of individuals counselled and tested for HIV. HIV prevalence in this population was 27.15% in January 1999. Between 1999-2000 in this workforce of 386, 58 of 102 (54%) individuals with HIV were identified through voluntary counselling and testing. Of these, 48 (82.8%) voluntarily entered the HIV treatment pathway. Condom distribution in the sugar mill increased 400% and the number of sexually transmitted infections treated at the mill decreased by 88% during this time period. Using AVERT software to model HIV infection over time a decrease in incidence of 91.67% from that expected in this population was calculated. 11 HIV infections were averted in a single year of this program. HIV/acquired immune deficiency syndrome (AIDS) is prevalent in the occupational setting in South Africa. This setting can provide a venue for HIV care and prevention. A package of care for HIV including prevention, education, and therapeutics can be effective in both providing care for HIV-infected individuals and preventing new infections.