Availability and Quality of Size Estimations of Female Sex Workers, Men Who Have Sex with Men, People Who Inject Drugs and Transgender Women in Low- and Middle-Income Countries

Abstract

ObjectiveTo assess the availability and quality of population size estimations of female sex workers (FSW), men who have sex with men (MSM), people who inject drug (PWID) and transgender women.MethodsSize estimation data since 2010 were retrieved from global reporting databases, Global Fund grant application documents, and the peer-reviewed and grey literature. Overall quality and availability were assessed against a defined set of criteria, including estimation methods, geographic coverage, and extrapolation approaches. Estimates were compositely categorized into ‘nationally adequate’, ‘nationally inadequate but locally adequate’, ‘documented but inadequate methods’, ‘undocumented or untimely’ and ‘no data.’FindingsOf 140 countries assessed, 41 did not report any estimates since 2010. Among 99 countries with at least one estimate, 38 were categorized as having nationally adequate estimates and 30 as having nationally inadequate but locally adequate estimates. Multiplier, capture-recapture, census and enumeration, and programmatic mapping were the most commonly used methods. Most countries relied on only one estimate for a given population while about half of all reports included national estimates. A variety of approaches were applied to extrapolate from sites-level numbers to national estimates in two-thirds of countries.ConclusionsSize estimates for FSW, MSM, PWID and transgender women are increasingly available but quality varies widely. The different approaches present challenges for data use in design, implementation and evaluation of programs for these populations in half of the countries assessed. Guidance should be further developed to recommend: a) applying multiple estimation methods; b) estimating size for a minimum number of sites; and, c) documenting extrapolation approaches.

The uptake of population size estimation studies for key populations in guiding HIV responses on the African continent

“…In a review of available size estimates for key populations, Sabin and colleagues noted that while many estimates are developed and submitted by national HIV/AIDS programs to UNAIDS, few estimates published in peer-reviewed literature were endorsed by national authoritative stakeholders, and thus were not used in national planning [20]. The low utilization of estimates in this review, particularly of estimates found in the peer-reviewed literature, reinforces this finding.…”

“…In some PSE studies, underestimations that limit the utility of PSE in informing programming may also play a role in the lack of reference to PSE studies in planning documents. This review did not assess PSE quality, but other reviews have documented that of African countries with existing PSE, about half are considered to have nationally adequate estimates [20].…”

“…A growing number of PSE studies have been undertaken for key populations over the past decade [18,20]. Despite this, there are still many countries where PSE for key populations are inaccurate, incomplete, or missing [20,21].…”

“…A growing number of PSE studies have been undertaken for key populations over the past decade [18,20]. Despite this, there are still many countries where PSE for key populations are inaccurate, incomplete, or missing [20,21]. A review assessing PSE for key populations among low and middle-income countries revealed that out of 54 countries on the African continent, less than half have published size estimation data for any key population, and of those with existing PSE, about half are considered to have nationally adequate estimates [20].…”

“…Despite this, there are still many countries where PSE for key populations are inaccurate, incomplete, or missing [20,21]. A review assessing PSE for key populations among low and middle-income countries revealed that out of 54 countries on the African continent, less than half have published size estimation data for any key population, and of those with existing PSE, about half are considered to have nationally adequate estimates [20]. Inaccurate and incomplete data are particularly common in countries where study participants may be at risk of arrest due to punitive laws criminalizing sex work, drug use, or non-heteronormative sexual practices [9].…”