Estimating Sizes of Key Populations at the National Level: Considerations for Study Design and Analysis

Edwards, Jessie K.; Hileman, Sarah Bassett; Donastorg, Yeycy; Zadrozny, Sabrina; Baral, Stefan; Hargreaves, James; Fearon, Elizabeth; Zhao, Jinkou; Datta, Abhirup; Weir, Sharon S.

doi:10.1097/ede.0000000000000906

Cited by 26 publications

(22 citation statements)

References 39 publications

(38 reference statements)

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“… Context : To achieve the “first 90” target, timely estimates of the number and proportion of persons with undiagnosed HIV infection are critical for countries to ensure that HIV testing programmes are targeted appropriately and efficiently . One recent study that analysed population‐based Demographic and Health Survey (DHS) data from 16 SSA countries estimated that only 54% of people living with HIV (range across countries 26% to 84%) were aware of their status, contributing to delays in care enrollment and ART initiation .…”

Section: Resultsmentioning

confidence: 99%

“…men who have sex with men [MSM], sex workers [SW], people who inject drugs [PWID], etc.) is difficult in contexts with unknown population size estimates . Research approaches : Population‐based studies, such as demographic and health surveys that evaluate the implementation of testing services, frequent (annual) targeted HIV sero‐prevalence surveys in sub‐national geographic areas, and biobehavioural surveys , may be necessary for monitoring this population‐level metric. Surveys should report estimates disaggregated by sex and age, with finer age disaggregations (e.g.…”

Section: Resultsmentioning

confidence: 99%

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Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

et al. 2019

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Introduction “Treat All” – the treatment of all people with HIV, irrespective of disease stage or CD4 cell count – represents a paradigm shift in HIV care that has the potential to end AIDS as a public health threat. With accelerating implementation of Treat All in sub‐Saharan Africa (SSA), there is a need for a focused agenda and research to identify and inform strategies for promoting timely uptake of HIV treatment, retention in care, and sustained viral suppression and addressing bottlenecks impeding implementation. Methods The Delphi approach was used to develop consensus around research priorities for Treat All implementation in SSA. Through an iterative process (June 2017 to March 2018), a set of research priorities was collectively formulated and refined by a technical working group and shared for review, deliberation and prioritization by more than 200 researchers, implementation experts, policy/decision‐makers, and HIV community representatives in East, Central, Southern and West Africa. Results and discussion The process resulted in a list of nine research priorities for generating evidence to guide Treat All policies, implementation strategies and monitoring efforts. These priorities highlight the need for increased focus on adolescents, men, and those with mental health and substance use disorders – groups that remain underserved in SSA and for whom more effective testing, linkage and care strategies need to be identified. The priorities also reflect consensus on the need to: (1) generate accurate national and sub‐national estimates of the size of key populations and describe those who remain underserved along the HIV‐care continuum; (2) characterize the timeliness of HIV care and short‐ and long‐term HIV care continuum outcomes, as well as factors influencing timely achievement of these outcomes; (3) estimate the incidence and prevalence of HIV‐drug resistance and regimen switching; and (4) identify cost‐effective and affordable service delivery models and strategies to optimize uptake and minimize gaps, disparities, and losses along the HIV‐care continuum, particularly among underserved populations. Conclusions Reflecting consensus among a broad group of experts, researchers, policy‐ and decision‐makers, PLWH, and other stakeholders, the resulting research priorities highlight important evidence gaps that are relevant for ministries of health, funders, normative bodies and research networks.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

et al. 2019

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“…Consequently, the SEs we present are not total population denominators. They are, however, higher than previous estimates – with the exception of those derived from the unique object multiplier method, which suffered from methodological challenges – and are comparable to recent SEs for the Dominican Republic . Nevertheless, it is important that efforts to reach KP do not overlook more hidden sub‐populations who may only socialize in private or only meet partners online.…”

Section: Discussionmentioning

confidence: 62%

“…SEs were also adjusted using data from individual interviews to account for venue‐visiting behaviours, such as visiting multiple sites in one day. We extrapolated the adjusted SEs to arrondissements we did not visit using Poisson regression . We did not calculate SEs for TGW since most venue informants could not accurately identify TGW.…”

Section: Methodsmentioning

confidence: 99%

“…Of particular concern is the lack of data on virologic suppression among KP on ART in Haiti, which is necessary to measure progress against UNAIDS 90‐90‐90 targets . Another gap is the lack of national and subnational‐level size estimates for KP, which are critical to inform national strategy around resource allocation, intervention planning and programme evaluation .…”

Section: Introductionmentioning

confidence: 99%

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The burden of HIV among female sex workers, men who have sex with men and transgender women in Haiti: results from the 2016 Priorities for Local AIDS Control Efforts (PLACE) study

et al. 2019

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Introduction Despite the higher risk of HIV among female sex workers (FSWs), men who have sex with men (MSM) and transgender women (TGW), these populations are under‐represented in the literature on HIV in Haiti. Here, we present the first nationally representative estimates of HIV prevalence and the first care and treatment cascade for FSWs, MSM and TGW in Haiti. We also examine the social determinants of HIV prevalence in these groups and estimate FSW and MSM population size in Haiti. Methods Data were collected between April 2016 and February 2017 throughout the 10 geographical departments of Haiti. The Priorities for Local AIDS Control Efforts (PLACE) method was used to: (1) recruit participants for a behavioural survey; (2) provide rapid testing, counselling and linkage to care for syphilis and HIV; and (3) measure viral load using dried blood spots for participants testing HIV positive. Results Study participants included 990 FSWs, 520 MSM and 109 TGW. HIV prevalence was estimated at 7.7% (95% CI 6.2%, 9.6%) among FSWs, 2.2% (0.9%, 5.3%) among MSM and 27.6% (5.0%, 73.5%) among TGW. Of participants who tested positive for syphilis, 17% of FSWs, 19% of MSM and 74% of TGW were co‐infected with HIV. Economic instability and intimate partner violence (IPV) were significantly associated with HIV among MSM; food insecurity, economic instability and history of rape were significantly associated with HIV among TGW. Fewer than one‐third of participants living with HIV knew their status, and more than a quarter of those who knew their status were not on treatment. While approximately four in five FSW and MSM participants on treatment for HIV were virally suppressed, viral suppression was less common among TGW participants at only 46%. Conclusions This study demonstrates a need for targeted interventions to prevent and treat HIV among key populations in Haiti. Potential high‐impact interventions may include venue‐based, peer navigator‐led outreach and testing for HIV and syphilis and improving screening and case management for structural violence and IPV. TGW are in urgent need of such interventions due to our observations of alarmingly high HIV prevalence and low frequency of HIV viral suppression among TGW.

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Getting resources to those who need them: the evidence we need to budget for underserved populations in sub‐Saharan Africa

et al. 2021

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Introduction In recent years, many countries have adopted evidence‐based budgeting (EBB) to encourage the best use of limited and decreasing HIV resources. The lack of data and evidence for hard to reach, marginalized and vulnerable populations could cause EBB to further disadvantage those who are already underserved and who carry a disproportionate HIV burden (USDB). We outline the critical data required to use EBB to support USDB people in the context of the generalized epidemics of sub‐Saharan Africa (SSA). Discussion To be considered in an EBB cycle, an intervention needs at a minimum to have an estimate of a) the average cost, typically per recipient of the intervention; b) the effectiveness of the intervention and c) the size of the intervention target population. The methods commonly used for general populations are not sufficient for generating valid estimates for USDB populations. USDB populations may require additional resources to learn about, access, and/or successfully participate in an intervention, increasing the cost per recipient. USDB populations may experience different health outcomes and/or other benefits than in general populations, influencing the effectiveness of the interventions. Finally, USDB population size estimation is critical for accurate programming but is difficult to obtain with almost no national estimates for countries in SSA. We explain these limitations and make recommendations for addressing them. Conclusions EBB is a strong tool to achieve efficient allocation of resources, but in SSA the evidence necessary for USDB populations may be lacking. Rather than excluding USDB populations from the budgeting process, more should be invested in understanding the needs of these populations.

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Estimating Sizes of Key Populations at the National Level: Considerations for Study Design and Analysis

Abstract: Viewing the size estimation of key populations as a missing data problem provides a framework for articulating and evaluating the assumptions necessary to obtain a national size estimate. In addition, this paradigm allows use of methods for missing data familiar to epidemiologists.

Cited by 26 publications

References 39 publications

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

Research priorities to inform “Treat All” policy implementation for people living with HIV in sub‐Saharan Africa: a consensus statement from the International epidemiology Databases to Evaluate AIDS (IeDEA)

The burden of HIV among female sex workers, men who have sex with men and transgender women in Haiti: results from the 2016 Priorities for Local AIDS Control Efforts (PLACE) study

Getting resources to those who need them: the evidence we need to budget for underserved populations in sub‐Saharan Africa

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