Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study

Doshi, Reena H.; Apodaca, Kevin; Ogwal, Moses; Bain, Rommel; Amene, Ermias; Kiyingi, Herbert; Aluzimbi, George; Musinguzi, Geofrey; Serwadda, David; McIntyre, Anne F; Hladik, Wolfgang

doi:10.2196/12118

Cited by 33 publications

(38 citation statements)

References 28 publications

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“…Kampala is the capital and business center of Uganda. It was selected on purpose because it is thought to have the largest number of people who inject drugs in Uganda [18]. Mbale Municipality, on the other hand, is one of the largest and busiest towns in eastern Uganda, but also a transit route from neighboring Kenya.…”

Section: Methodsmentioning

confidence: 99%

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When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

Baluku¹,

Wamala²

2019

Harm Reduct J

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Background: In Uganda, injection drug use is a growing but less studied problem. Preventing the transition to injection drug use may help prevent blood-borne viral transmission, but little is known about when and how people transition to injection drug use. A greater understanding of this transition process may aid in the country's efforts to prevent the continued growth of injection drug use, HIV, and hepatitis C Virus (HCV) infection among people who inject drugs (PWID). Methods: Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)-recruited through outreach and snow-ball sampling. Participants were interviewed about their experiences on when and how they transitioned into injection drug use and these issues were also discussed in 12 focus groups held with the participants.Results: All the study participants started their drug use career with non-injecting forms including chewing, smoking, and sniffing before transitioning to injecting. Transitioning was generally described as a peer-driven and socially learnt behavior. The participants' social networks and accessibility to injectable drugs on the market and among close friends influenced the time lag between first regular drug use and first injecting-which took an average of 4.5 years. By the age of 24, at least 81.6% (95.7% for females and 78.4% for males) had transitioned into injecting. Over 84.8% shared injecting equipment during their first injection, 47.2% started injecting because a close friend was already injecting, 26.4% desired to achieve a greater "high" (26.4%) which could reflect drug-tolerance, and 12% out of curiosity.Conclusions: Over 81% non-injecting drug users in Kampala and Mbale districts transitioned into injecting by the age of 24; a process that reproduces a population of PWID but also puts them at increased risk of HIV and HCV infection. As Uganda makes efforts to introduce and/or strengthen harm reduction services, interventions targeting non-injecting drug users before they transition into injecting should be considered as a key component for HIV/HCV epidemic control efforts, and their evaluation considered in future researches.

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Section: Methodsmentioning

confidence: 99%

“…In Uganda, there is limited data on PWID. In 2017, the estimated number of PWID in Kampala was 3892 (3090-5126) [18]. The HIV prevalence among PWID is estimated at 45% compared to 15% in Kenya and 20% in Tanzania [19][20][21][22][23].…”

Section: Introductionmentioning

confidence: 99%

When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

Baluku¹,

Wamala²

2019

Harm Reduct J

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“…In Uganda, the Global Sate of Harm report and studies conducted by Makerere University Crane Surveys have estimated HIV prevalence among people who inject drugs (PWID) at approximately 17% [1,11]. In 2018, the Kampala Place Study estimated over 18,000 people who inject drugs (PWID) in Uganda [15]. A high number of women who use injection and non-injection drugs report selling sex (79%) and may have significantly higher rates of HIV infection [16].…”

Section: Introductionmentioning

confidence: 99%

Injection and sexual risk among people who use or inject drugs in Kampala, Uganda: An exploratory qualitative study

Dickson‐Gómez

Wamala²,

Christenson

et al. 2020

PLoS ONE

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Background Countries in Sub-Saharan Africa (SSA) have seen rapid increases in injection drug use since 2008. In Uganda, the Global Sate of Harm report and studies conducted by Makerere University Crane Surveys have estimated HIV prevalence among people who inject drugs (PWID) at approximately 17%. The objective of the research was to document injection and other drug-related risks among people who use drugs in Uganda to develop comprehensive HIV/HCV prevention interventions. Methods Between August and September 2018, we conducted qualitative interviews among male and female people who use drugs. Interview topics included the availability and accessibility of clean syringes, injection risks, overdose, sexual-risk behaviors, and the availability and accessibility of harm reduction and drug treatment services. Results Participants reported several injection-related risks including sharing and reusing syringes, pooling and mixing drugs in the same container, measuring drugs using syringes, getting prefilled injections from dealers, being injected by other people who inject drugs, and using contaminated water or blood to dilute drugs. Participants reported a scarcity of harm reduction services, although a few appear to have participated in the syringe exchange pilot conducted by the Uganda Harm Reduction Network (UHRN). Even fewer reported knowing organizations that helped people who use drugs abstain from or reduce their use. Medication assisted therapy (MAT) and naloxone to reverse overdoses are not currently available.

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“…Bias may exist because on some occasions key populations would surround the researcher who is distributing the objects because they hope to get the object. The choice of an appropriate unique object and distributors are of vital importance to guarantee a successful capture-recapture sampling (28,29). This approach is highly adaptable for key populations such as drug users and sex workers.…”

Section: Resultsmentioning

confidence: 99%

Methods for Estimating Population Size for Key Populations: A Global Scoping Review for HIV Research

Xu¹,

Jing²,

Lü³

et al. 2021

Preprint

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Background: Estimating the population sizes of key populations is critical for understanding the overall HIV burden. This scoping review aims to synthesize existing methods for population size estimation among key populations (people who inject drugs, men who have sex with men (MSM), transgender persons, sex workers, and incarcerated individuals), and provide recommendations for future application of the existing methods.Main text: A scoping review was conducted and 39 of 688 studies met the inclusion criteria and were assessed. Estimation methods included five digital methods, one in-person method, and four hybrid methods. We summarized and organized the methods for population size estimation into the following five categories: methods based on independent samples (including capture-recapture method and multiplier method), methods based on population counting (including Delphi method and mapping method), methods based on the official report (including workbook method), methods based on social network (including respondent-driven sampling method and network scale-up method) and methods based on data-driven technologies (Bayesian estimation method, Stochastic simulation method, and LMS estimation method). 36 (92%) articles were published after 2010 and 23 (59%) used multiple methods. These include 11 in high-income countries and 28 in low-income countries. A total of 10 estimates the size of sex workers, 14 focused on MSM, and 10 focused on PWID. Conclusion: There was no gold standard for population size estimation. Among 120 studies that were related to population size estimation of key populations, the most commonly used population estimation method is the multiplier method (26/120 studies). Every method has its strengths. For example, some traditional methods are simple and easy to use for researchers. Some novel methods are time- and resources- saving. However, each method has its limitations and bias. For example, for the respondent-driven sampling method, stigma and discrimination may lead to the "hiddenness" of the key population; for the multiplier method, the quality of authentic data may also influence the accuracy of the estimation. In recent years, novel methods based on data-driven technologies such as Bayesian estimation have been developed and applied in many surveys.

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Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study

Cited by 33 publications

References 28 publications

When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

Injection and sexual risk among people who use or inject drugs in Kampala, Uganda: An exploratory qualitative study

Methods for Estimating Population Size for Key Populations: A Global Scoping Review for HIV Research

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