Patterns of Workplace Absenteeism Across Levels of Virological Failure Among Employed Adults Co-Infected with HIV and Pulmonary Tuberculosis in the Govan Mbeki Sub-District, South Africa: A Retrospective Record Review.

Background/Objectives: Human immunodeficiency virus (HIV) and tuberculosis (TB) remain major public health challenges in sub-Saharan Africa, which bears the highest burden of HIV/TB co-infection. Evidence is limited on whether the severity of virological failure is associated with workplace absenteeism among employed adults with HIV/PTB co-infection. This study examined workplace absenteeism across two viral-load categories among employed adults with documented virological failure in the Govan Mbeki sub-district. Methods: A retrospective record review with secondary data analysis was conducted among 286 employed mine workers with HIV/PTB co-infection and a viral load ≥1000 copies/mL after at least six months of antiretroviral therapy (ART). Clinical data were extracted from medical, laboratory, and TB-treatment records and linked to workplace sick-leave registers; limited participant contact was used only to clarify essential missing information. The analytic dataset had an observed minimum viral load of 1200 copies/mL. Viral load was categorised as 1200-10,000 versus ≥10,001 copies/mL. Absenteeism was the number of recorded sick-leave days during the preceding three months and, for logistic regression, was classified as low (5-10 days) versus high (11-15 days). Multivariable logistic regression was adjusted for age, sex, education, and structural/socioeconomic barrier score. Results: Mean absenteeism was 10.05 days (SD = 2.44). Of 286 participants, 181 (63.3%) had a viral load ≥10,001 copies/mL and 105 (36.7%) had a viral load of 1200-10,000 copies/mL. High absenteeism occurred in 129 participants (45.1%) and lower absenteeism in 157 (54.9%). Viral load category was not associated with high absenteeism after adjustment (aOR = 1.21, 95% CI: 0.76-1.92; p = 0.432). The model was not statistically significant (χ2 = 6.41, df = 5, p = 0.269), explained 3.0% of the variance (Nagelkerke R2 = 0.030), and had an acceptable Hosmer-Lemeshow fit (p = 0.913). Conclusions: Within this selected employed cohort with virological failure, high-level virological failure and absenteeism were both common, but no evidence of an independent association between viral-load category and high absenteeism was detected. The cross-sectional temporal structure, healthy-worker selection, limited exposure contrast, and residual confounding constrain causal interpretation. Integrated public health and workplace interventions are suggested to improve both treatment outcomes and workforce participation in high-burden settings.