Abstract: We found one RCT with 174 participants and five CBAs with 48,058 participants assessing the effectiveness of vocational training (n = 1) and antiretroviral therapy (ART) (n = 5). We found no studies assessing psychological interventions. The one RCT was conducted in the United States; the five CBA studies were conducted in South Africa, India, Kenya, and Uganda. We graded all six studies as having a high risk of bias. The effectiveness of vocational intervention was assessed in only one study but we could not infer the intervention effect due to a lack of data. For pharmacological interventions, we found very low-quality evidence for a beneficial effect of ART on employment outcomes in five studies. Due to differences in outcome measurement we could only combine the results of two studies in a meta-analysis. Two studies compared employment outcomes of HIV+ persons on ART therapy to healthy controls. One study found a MD of -1.22 days worked per month (95% confidence interval (CI) -1.74 to -1.07) at 24-months follow-up. The other study found that the likelihood of being employed steadily increased for HIV+ persons compared to healthy individuals from ART initiation (OR 0.35, 95% CI 0.26 to 0.47) to three- to five-years follow-up (OR 0.73, 95% CI 0.42 to 1.28). Three other studies compared HIV+ persons on ART to HIV+ persons not yet on ART. Two studies indicated an increase in the likelihood of employment over time due to the impact of ART for HIV+ persons compared to HIV+ persons pre-ART (OR 1.75, 95% CI 1.44 to 2.12). One study found that the group on ART worked 12.1 hours more (95% CI 6.99 to 17.21) per week at 24-months follow-up than the average of the cohort of ART and pre-ART HIV+ persons which was 20.1 hours. We rated the evidence as very low quality for all comparisons due to a high risk of bias. We found very low-quality evidence showing that ART interventions may improve employment outcomes for HIV+ persons. For vocational interventions, the one included study produced no evidence of an intervention effect. We found no studies that assessed psychological interventions. We need more high-quality, preferably randomized studies to assess the effectiveness of RTW interventions for HIV+ persons.

Plain-language summary: We found five controlled before-after (CBA) studies from South Africa, India, Uganda, and Kenya and one randomized controlled trial from the USA. The studies included over 48,000 participants. Five studies examined antiretroviral therapy and one study examined vocational interventions as a way of improving return to work in HIV+ people. The five CBA studies found that antiretroviral therapy interventions may increase employment outcomes in HIV+ people. One study assessed the effect of making changes to work tasks or the work environment but did not report enough data to say if it helped or not. We found no studies on psychological support to help HIV+ people cope better. Overall, we found very low-quality evidence because the included studies all had a high risk of bias. We found very low-quality evidence that antiretroviral therapy interventions could improve employment outcomes for HIV+ people. We need high-quality, randomized trials to find out if pharmacological, vocational, and psychological interventions can improve employment outcomes for HIV+ people.