Opportunities for Enhanced Strategic Use of Surveys, Medical Records, and Program Data for HIV Surveillance of Key Populations: Scoping Review

Abstract

BackgroundNormative guidelines from the World Health Organization recommend tracking strategic information indicators among key populations. Monitoring progress in the global response to the HIV epidemic uses indicators put forward by the Joint United Nations Programme on HIV/AIDS. These include the 90-90-90 targets that require a realignment of surveillance data, routinely collected program data, and medical record data, which historically have developed separately.ObjectiveThe aim of this study was to describe current challenges for monitoring HIV-related strategic information indicators among key populations ((men who have sex with men [MSM], people in prisons and other closed settings, people who inject drugs, sex workers, and transgender people) and identify future opportunities to enhance the use of surveillance data, programmatic data, and medical record data to describe the HIV epidemic among key populations and measure the coverage of HIV prevention, care, and treatment programs.MethodsTo provide a historical perspective, we completed a scoping review of the expansion of HIV surveillance among key populations over the past three decades. To describe current efforts, we conducted a review of the literature to identify published examples of SI indicator estimates among key populations. To describe anticipated challenges and future opportunities to improve measurement of strategic information indicators, particularly from routine program and health data, we consulted participants of the Third Global HIV Surveillance Meeting in Bangkok, where the 2015 World Health Organization strategic information guidelines were launched.ResultsThere remains suboptimal alignment of surveillance and programmatic data, as well as routinely collected medical records to facilitate the reporting of the 90-90-90 indicators for HIV among key populations. Studies (n=3) with estimates of all three 90-90-90 indicators rely on cross-sectional survey data. Programmatic data and medical record data continue to be insufficiently robust to provide estimates of the 90-90-90 targets for key populations.ConclusionsCurrent reliance on more active data collection processes, including key population-specific surveys, remains warranted until the quality and validity of passively collected routine program and medical record data for key populations is optimized.

Who Accepts and Who Uses Community-Based Secondary Distribution HIV Self-Testing (HIVST) Kits? Findings From the Intervention Arm of a Cluster-Randomized Trial of HIVST Distribution Nested in Four HPTN 071 (PopART) Communities in Zambia

“…Additional strengths are: we have been transparent about challenges and assumptions, highlight the importance of program data and opportunities for learning where such data are used strategically. 27 Findings are generalizable to high prevalence HIV settings with regular exposure to HTS.…”

Global, regional and country-level 90–90–90 estimates for 2018

“…In concentrated epidemics, where HIV infections occur primarily in key populations and their partners, an optimized mix of routine and targeted testing services is needed. As more and more countries reach the 90-90-90 target, improved methods are needed to accurately collect information on how people may have acquired their infection to estimate progress towards the target among key populations [37].…”

Do combination HIV prevention programmes result in increased empowerment, inclusion and agency to demand equal rights for marginalised populations in low-income and middle-income countries? A systematic review

“…The interventions also favoured tackling social rather than political and/or economic facets of the issues; there were only five subcomponents that tackled financial security. However, existing literature indicates that there is a need to tackle these ‘higher’ and more complicated structural issues, which can present significant constraints to HIV prevention success and intervention sustainability and drive up the disease burden, in order to systematically improve the socioeconomic status and (comprehensive, including psychological and mental) healthcare of the populations 3 10 15 50–57. This argument is, nevertheless, not meant to downplay the importance of and need to tackle the ‘lower’ level structural issues and the non-structural interventions as well as the challenges in dealing with the bigger picture 10 51 53 56 57…”