Consolidated Guidelines

2.13.1 Establish schemes for reasonable accommodation and compensation, including, as appropriate, paid leave, early retirement benefits and death benefits in the event of occupationally-acquired disease.

The 17 survey confirmed what had often been noted in qualitative studies consisting of interviews and focus group with worker representatives and unions, namely that compensation systems for workers with HIV and TB have been problematic. Although laws are generally in existence that apply to all workers including health workers, they have been difficult to interpret and implement. Most policies have lacked specific reference and guidance to compensation of health workers with HIV sero-conversion/AIDS and/or TB infection from health care settings.

2.11.2 Key References and Supporting WHO Guidelines

Bezanson, K., Pouteau, K., Mnthambala, A., Stephany, P., Chiwewe, D., Kumumbala, R., et al. (2006). Do health care workers with HIV/AIDS have delayed initiation of antiretroviral therapy and higher mortality when compared with other patients in Malawi? XVI International AIDS Conference, Toronto, Canada.

Corbett EL, Dauya E, Matambo R, Cheung YB, Makamure B, Bassett MT, et al. (2006). Uptake of workplace HIV counselling and testing: A cluster-randomised trial in Zimbabwe. PLoS Medicine, 3(7), e238.

2.10.1 Provide universal availability of free and timely PEP to all health care providers, for both occupational and non-occupational exposures, with appropriate training of counsellors and information on the benefits and risks provided to all staff.

The rationale for post-exposure prophylaxis is set out in detail in the WHO guideline on PEP based on the pathogenesis of HIV infection, the biological plausibility that using antiretroviral drugs can prevent transmission and the risk and benefits of post-exposure prophylaxis to exposed healthcare workers.

2.9.1 Establish and provide adequate financial resources for treatment, care and support programmes to prevent the occupational or non- occupational transmission of HIV and TB among health workers.

As discussed above, it is now well established that the health workforce is at higher risk than the general population of exposure to infectious diseases generally. While there is no dispute as to the importance of occupational transmission of TB, as discussed as well by Wheeler (2009), there is less consensus regarding the importance of occupational HIV, albeit at least 4-5% of HIV is thought to have been acquired at work. Nonetheless there are few studies that explore the allocation of resources and programmes in this regard.

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