Programmatic Mapping to Estimate Size, Distribution, and Dynamics of Key Populations in Kosovo

Mapping Key Populations to Develop Improved HIV and AIDS Interventions: Multiphase Cross-Sectional Observational Mapping Study Using a District and City Approach

BACKGROUND

Indonesia's vast archipelago and substantial population size present unique challenges in addressing its multifaceted HIV epidemic, with 90% of its 514 districts and cities reporting cases. Identifying key populations (KPs) is essential for effectively targeting interventions and allocating resources to address the changing dynamics of the epidemic.

OBJECTIVE

We examine the 2022 mapping of Indonesia's KPs to develop improved HIV and AIDS interventions.

METHODS

In 2022, a district-based mapping of KPs was conducted across 201 districts and cities chosen for their HIV program intensity. This multiphase process included participatory workshops for hotspot identification, followed by direct hotspot observation, then followed by a second direct observation in selected hotspots for quality control. Data from 49,346 informants (KPs) were collected and analyzed. The results from individual hotspots were aggregated at the district or city level, and a formula was used to estimate the population size.

RESULTS

The mapping initiative identified 18,339 hotspots across 201 districts and cities, revealing substantial disparities in hotspot distribution. Of the 18,339 hotspots, 16,964 (92.5%) were observed, of which 1822 (10.74%) underwent a second review to enhance data accuracy. The findings mostly aligned with local stakeholders' estimates, but showed a lower median. Interviews indicated a shift in KP dynamics, with a median decline in hotspot attendance since the pandemic, and there was notable variation in mapping results across district categories. In "comprehensive" areas, the average results for men who have sex with men (MSM), people who inject drugs, transgender women, and female sex workers (FSWs) were 1008 (median 694, IQR 317-1367), 224 (median 114, IQR 59-202), 196 (median 167, IQR 81-265), and 775 (median 573, IQR 352-1131), respectively. "Medium" areas had lower averages: MSM at 381 (median 199, IQR 91-454), people who inject drugs at 51 (median 54, IQR 15-63), transgender women at 101 (median 55, IQR 29-127), and FSWs at 304 (median 231, IQR 118-425). "Basic" areas showed the lowest averages: MSM at 161 (median 73, IQR 49-285), people who inject drugs at 7 (median 7, IQR 7-7), transgender women at 59 (median 26, IQR 12-60), and FSWs at 161 (median 131, IQR 59-188). Comparisons with ongoing outreach programs revealed substantial differences: the mapped MSM population was >50% lower than program coverage; the estimates for people who inject drugs were twice as high as the program coverage.

CONCLUSIONS

The mapping results highlight significant variations in hotspots and KPs across districts and cities and underscore the necessity of adaptive HIV prevention strategies. The findings informed programmatic decisions, such as reallocating resources to underserved districts and recalibrating outreach strategies to better match KP dynamics. Developing strategies beyond identified hotspots, integrating mapping data into planning, and adopting a longitudinal approach to understand KP behavior over time are critical for effective HIV and AIDS prevention and control.

Online commercial sex-seeking among female sex workers in south China: a cross-sectional study

BACKGROUND

Online communication platforms have the potential to facilitate commercial sex among female sex workers (FSW), increasing the risk of contracting sexually transmitted diseases (STD). This study aimed to describe the patterns of online commercial sex-seeking and examine the associated factors among FSW in China.

METHODS

A venue-based cross-sectional study was conducted in five cities in Guangdong Province, China, between April and October 2020. Data on socio-demographic characteristics, sexual behaviors, and online commercial sex-seeking patterns were collected through face-to-face interviews. Venous blood and urine samples were collected for STD testing. Univariate and multivariable logistic regressions were used to explore the factors associated with online commercial sex-seeking.

RESULTS

A total of 1155 FSW were recruited in physical venues for this study. Among them, 33.42% reported ever using online applications to seek commercial sex. The prevalence of HIV, syphilis, gonorrhea, chlamydia, and STD was 0.26%, 1.30%, 4.40%, 15.54%, and 18.39%, respectively, among FSW who had ever used both physical and online venues to seek commercial sex, which was higher than among FSW who had never sought commercial sex online. Multivariable logistic regression indicated that FSW who used online platforms to seek commercial sex were more likely to have STD (adjusted odds ratio (aOR) = 1.48, 95%CI: 1.05-2.09), experience unintended pregnancies due to commercial sex (aOR = 1.78, 95%CI: 1.21-2.62), be diagnosed as infertile (aOR = 3.20, 95%CI: 1.42-7.21), and undergo abortions (aOR = 1.69, 95%CI: 1.29-2.20).

CONCLUSION

A significant proportion of FSW who practiced in physical venues in China engaged in seeking commercial sex online, and this behavior is positively correlated with both STD and reproductive health outcomes. Given the high prevalence of online sex-seeking, it is crucial to provide a wide range of internet-based healthcare interventions and reproductive health services to Chinese FSW.

Summarizing methods for estimating population size for key populations: a global scoping review for human immunodeficiency virus research

BACKGROUND

Estimating the population sizes of key populations(people who inject drugs, men who have sex with men, transgender persons, and commercial sex workers) is critical for understanding the overall Human Immunodeficiency Virus burden. This scoping review aims to synthesize existing methods for population size estimation among key populations, and provide recommendations for future application of the existing methods.

METHODS

Relevant studies published from 1st January 2000 to 4th August 2020 and related to key population size estimation were retrieved and 120 of 688 studies were assessed. After reading the full texts, 81 studies were further excluded. Therefore, 39 studies were included in this scoping review. Estimation methods included five digital methods, one in-person method, and four hybrid methods.

FINDING

We summarized and organized the methods for population size estimateion 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 Laska, Meisner, and Siegel estimation method). Thirty-six (92%) articles were published after 2010 and 23 (59%) used multiple methods. Among the articles published after 2010, 11 in high-income countries and 28 in low-income countries. A total of 10 estimated the size of commercial sex workers, 14 focused on men who have sex with men, and 10 focused on people who inject drugs.

CONCLUSIONS

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 and biases. In recent years, novel methods based on data-driven technologies such as Bayesian estimation have been developed and applied in many surveys.

shinyrecap: A Shiny Application for Population Size Estimation from Capture-Recapture Data (Preprint)

Background

Population size estimates (PSE) provide critical information in determining resource allocation for HIV services geared toward those at high risk of HIV, including female sex workers, men who have sex with men, and people who inject drugs. Capture-recapture (CRC) is often used to estimate the size of these often-hidden populations. Compared with the commonly used 2-source CRC, CRC relying on 3 (or more) samples (3S-CRC) can provide more robust PSE but involve far more complex statistical analysis.

Objective

This study aims to design and describe the Shiny application (shinyrecap), a user-friendly interface that can be used by field epidemiologists to produce PSE.

Methods

shinyrecap is built on the Shiny web application framework for R. This allows it to seamlessly integrate with the sophisticated CRC statistical packages (eg, Rcapture, dga, LCMCR). Additionally, the application may be accessed online or run locally on the user’s machine.

Results

The application enables users to engage in sample size calculation based on a simulation framework. It assists in the proper formatting of collected data by providing a tool to convert commonly used formats to that used by the analysis software. A wide variety of methodologies are supported by the analysis tool, including log-linear, Bayesian model averaging, and Bayesian latent class models. For each methodology, diagnostics and model checking interfaces are provided.

Conclusions

Through a use case, we demonstrated the broad utility of this powerful tool with 3S-CRC data to produce PSE for female sex workers in a subnational unit of a country in sub-Saharan Africa.

Programmatic mapping and size estimation of female sex workers, transgender sex workers and men who have sex with men in İstanbul and Ankara, Turkey

OBJECTIVES

Despite a growing HIV threat, there is no definition and characterisation of key populations (KPs), who could be the major drivers of the epidemic in Turkey. We used programmatic mapping to identify locations where KPs congregate, estimate their numbers and understand their operational dynamics to develop appropriate HIV programme implementation strategies.

METHODS

Female and transgender sex workers (FSWs and TGSWs), and men who have sex with men (MSM) were studied in İstanbul and Ankara. Within each district, hot spots were identified by interviewing key informants and a crude spot list in each district was developed. The spot validation process was led by KP members who facilitated spot access and interviews of KPs associated with that spot. Final estimates were derived by aggregating the estimated number of KPs at all spots, which was adjusted for the proportion of KPs who visit multiple spots, and for the proportion of KPs who do not visit spots.

RESULTS

FSWs were the largest KP identified in İstanbul with an estimate of 30 447 (5.8/1000 women), followed by 15 780 TGSWs (2.9/1000 men) and 11 656 MSM (2.1/1000). The corresponding numbers in Ankara were 9945 FSWs (5.2/1000 women), 1770 TGSWs (1/1000 men) and 5018 MSM (2.5/1000 men). Each KP had unique typologies based on the way they find and interact with sex partners. MSM were mostly hidden and a higher proportion operated through internet and phone-based applications. Night time was the peak time with Friday, Saturday and Sunday being the peak days of activity in both İstanbul and Ankara.

CONCLUSIONS

This study has highlighted the presence of a substantial number of FSWs, TGSW and MSM in İstanbul and Ankara. The information obtained from this study can be used to set priorities for resource allocation and provide HIV prevention services where coverage could be the highest.