Occupational settings

HIV Voluntary Counseling and Testing (VCT) and education programs can increase VCT rates, reduce risky sexual behavior, and reduce the incidence of STDs when provided to workers in occupational settings.

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Photo credit: Tran Thi Hoa

Why are workplace HIV interventions important to review?

  • Some occupations are at higher risk for HIV infection and transmission, for example, those in the military, migrant workers, truck drivers and others, especially those with high mobility. Behavioural interventions (such as education, training and counseling at the individual or group level) offered at the workplace provide the opportunity to reach people who share similar high risk behaviours due to the nature of their work.

Do workplace HIV interventions work?

  • Work site voluntary testing and counselling (VCT) leads to increased uptake of testing, and decreased incidence of STD and unprotected sex. Onsite education also decreases STDs and unprotected sex and can decrease sex with commercial sex workers.

Equity: Do workplace HIV interventions work in disadvantaged populations?

  • The interventions were aimed at workers in high risk occupations around the world. Workplace interventions could reduce the risk of HIV among those disadvantaged due to occupation.

Intervention Delivery

  • VCT interventions: on-site VCT to vouchers for off-site VCT, VCT compared to brief HIV education, VCT on its own or combined with peer education compared to VCT only.
  • Education interventions: One used video-based education (five 90-minute videos), and information, motivation, behavioural skills (IMB) sessions provided in five 4-hour sessions, four 2-hour sessions, and one 4-hour session.
  • Education programs used the IMB theory and were led by peer educators, civilian facilitators, social workers.

 Population and Setting

  • 6 of the 8 studies were conducted in developing countries: 4 in Africa (countries not specified), India, and Thailand. One study was conducted in the US and one in Hong Kong.

  • The majority of participants were factory workers and included those in the construction industry, production of industrial goods, clothes or food, and telecommunication. Other occupations included truck drivers, and the military.
  • All participants were older than 18 and two studies included only women.

Summary of Findings [SOF] Table: On site voluntary testing an counselling compared to Voucher for offsite VCT for uptake of HIV testing

Patient or population: patients with uptake of HIV testing
Settings: occupational
Intervention: On site voluntary testing and counseling

Comparison: Voucher for offsite VCT

Outcomes

Illustrative comparative risks (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Risk without on-site VCT (voucher for offsite VCT)

Risk with on-site VCT

Uptake of testing

4 per 1000

50 more per 1000 (from 42 to 61 more)

OR 26.8 (22.2-32.3)

7482
(1 study)

Moderate1

Adverse events: none reported

GRADE Working Group grades of evidence
High quality (High): Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality (Moderate): Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality (Low): Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality (Very Low): We are very uncertain about the estimate.

1 Outcomes reported were entirely different from those in the registered protocol in Corbett 2006

Relevance of the review for disadvantaged communities

HIV Voluntary Counseling and Testing (VCT) and education programs can increase VCT rates, reduce risky sexual behavior, and reduce the incidence of STDs when provided to workers in occupational settings.
The interventions were aimed at workers in high risk occupations around the world

Findings

Interpretation

Equity – Which of the PROGRESS groups examined

 

Almost all included studies were conducted in low and middle income countries.

The results of the review are likely to be applicable for high-risk occupations in other low and middle income countries. Policymakers should determine which occupations are highest risk as well as which intervention is most appropriate in the local setting.

Some occupations are at higher risk than others for HIV infections – e.g. migrant workers, truck drivers, etc. However this study did not solely look at studies from high risk occupational settings

Workplace interventions are feasible and effective for improving HIV testing and knowledge. Further research should examine which interventions are most effective and focus on high risk occupations.

Vulnerability of migrant workers is compounded by poverty and low awareness about HIV and its prevention.

Policymakers implementing workplace interventions should address low HIV awareness in workplace settings in addition to providing on-site testing and counselling.

The review did not report of differential effects of the interventions on males and females.

Future studies should examine whether there are differences in intervention effectiveness among gender subgroups, as well as different occupations.

Equity Applicability

 

There are some positive impacts from workplace interventions in increasing HIV VCT, reducing STD incidence, unprotected sex and sex with commercial sex workers.

Policy makers should consider these results within the context of their local setting. The interventions in this review were varied and included VCT, VCT plus education, peer education, and information, motivation, and behavioural skills training of various duration and frequencies. Policymakers need to determine which intervention is most appropriate.

Cost-equity

 

The costs, cost-equity, or cost-effectiveness of the intervention was not reported in any of the studies.

Policymakers implementing workplace HIV prevention interventions need to consider the costs and benefits of the intervention. Workplace interventions targeting high risk occupations have the potential to improve cost equity.

Monitoring & Evaluation for PROGRESS Groups

 

All intervention should include a plan for monitoring and evaluation. VCT resulted in lower self-reported STD rates and decreased unprotected sex.

Policymakers should include monitoring and evaluation to determine whether the intervention is effective and whether it is effective for all subgroups of the population. Long-term follow up is needed to determine the effectiveness over time.

Comments on this summary? Please contact Jennifer Petkovic.