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Tuyishime E, Remera E, Kayitesi C, Malamba S, Sangwayire B, Habimana Kabano I, Ruisenor-Escudero H, Oluoch T, Unna Chukwu A. Estimation of the Population Size of Street- and Venue-Based Female Sex Workers and Sexually Exploited Minors in Rwanda in 2022: 3-Source Capture-Recapture. JMIR Public Health Surveill 2024; 10:e50743. [PMID: 38488847 PMCID: PMC10980986 DOI: 10.2196/50743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/25/2023] [Accepted: 01/10/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND HIV surveillance among key populations is a priority in all epidemic settings. Female sex workers (FSWs) globally as well as in Rwanda are disproportionately affected by the HIV epidemic; hence, the Rwanda HIV and AIDS National Strategic Plan (2018-2024) has adopted regular surveillance of population size estimation (PSE) of FSWs every 2-3 years. OBJECTIVE We aimed at estimating, for the fourth time, the population size of street- and venue-based FSWs and sexually exploited minors aged ≥15 years in Rwanda. METHODS In August 2022, the 3-source capture-recapture method was used to estimate the population size of FSWs and sexually exploited minors in Rwanda. The field work took 3 weeks to complete, with each capture occasion lasting for a week. The sample size for each capture was calculated using shinyrecap with inputs drawn from previously conducted estimation exercises. In each capture round, a stratified multistage sampling process was used, with administrative provinces as strata and FSW hotspots as the primary sampling unit. Different unique objects were distributed to FSWs in each capture round; acceptance of the unique object was marked as successful capture. Sampled FSWs for the subsequent capture occasions were asked if they had received the previously distributed unique object in order to determine recaptures. Statistical analysis was performed in R (version 4.0.5), and Bayesian Model Averaging was performed to produce the final PSE with a 95% credibility set (CS). RESULTS We sampled 1766, 1848, and 1865 FSWs and sexually exploited minors in each capture round. There were 169 recaptures strictly between captures 1 and 2, 210 recaptures exclusively between captures 2 and 3, and 65 recaptures between captures 1 and 3 only. In all 3 captures, 61 FSWs were captured. The median PSE of street- and venue-based FSWs and sexually exploited minors in Rwanda was 37,647 (95% CS 31,873-43,354), corresponding to 1.1% (95% CI 0.9%-1.3%) of the total adult females in the general population. Relative to the adult females in the general population, the western and northern provinces ranked first and second with a higher concentration of FSWs, respectively. The cities of Kigali and eastern province ranked third and fourth, respectively. The southern province was identified as having a low concentration of FSWs. CONCLUSIONS We provide, for the first time, both the national and provincial level population size estimate of street- and venue-based FSWs in Rwanda. Compared with the previous 2 rounds of FSW PSEs at the national level, we observed differences in the street- and venue-based FSW population size in Rwanda. Our study might not have considered FSWs who do not want anyone to know they are FSWs due to several reasons, leading to a possible underestimation of the true PSE.
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Affiliation(s)
- Elysee Tuyishime
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Eric Remera
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre, Rwanda Ministry of Health, Kigali, Rwanda
| | - Catherine Kayitesi
- Institute of HIV Disease Prevention and Control, Rwanda Biomedical Centre, Rwanda Ministry of Health, Kigali, Rwanda
| | - Samuel Malamba
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Beata Sangwayire
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | | | - Horacio Ruisenor-Escudero
- Key Population Surveillance Team, Epidemiology and Surveillance Branch, Division of Global HIV/TB, Global Health Center, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tom Oluoch
- Division of Global HIV and TB, Global Health Center, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Angela Unna Chukwu
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
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Kim BJ, Johnston LG, Grigoryan T, Papoyan A, Grigoryan S, McLaughlin KR. Hidden population size estimation and diagnostics using two respondent-driven samples with applications in Armenia. Biom J 2023; 65:e2200136. [PMID: 36879484 DOI: 10.1002/bimj.202200136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 11/03/2022] [Accepted: 11/30/2022] [Indexed: 03/08/2023]
Abstract
Estimating the size of hidden populations is essential to understand the magnitude of social and healthcare needs, risk behaviors, and disease burden. However, due to the hidden nature of these populations, they are difficult to survey, and there are no gold standard size estimation methods. Many different methods and variations exist, and diagnostic tools are needed to help researchers assess method-specific assumptions as well as compare between methods. Further, because many necessary mathematical assumptions are unrealistic for real survey implementation, assessment of how robust methods are to deviations from the stated assumptions is essential. We describe diagnostics and assess the performance of a new population size estimation method, capture-recapture with successive sampling population size estimation (CR-SS-PSE), which we apply to data from 3 years of studies from three cities and three hidden populations in Armenia. CR-SS-PSE relies on data from two sequential respondent-driven sampling surveys and extends the successive sampling population size estimation (SS-PSE) framework by using the number of individuals in the overlap between the two surveys and a model for the successive sampling process to estimate population size. We demonstrate that CR-SS-PSE is more robust to violations of successive sampling assumptions than SS-PSE. Further, we compare the CR-SS-PSE estimates to population size estimations using other common methods, including unique object and service multipliers, wisdom of the crowd, and two-source capture-recapture to illustrate volatility across estimation methods.
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Affiliation(s)
- Brian J Kim
- Joint Program in Survey Methodology, University of Maryland, College Park, Maryland, USA
| | - Lisa G Johnston
- Independent Consultant, LGJ Consultants, Inc., Valencia, Spain
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Bolo A, Ochira P, Hakim AJ, Katoro J, Bunga S, Lako R, Anib V, Arkangelo GC, Lobojo BN, Okiria AG. Limited awareness of HIV Status hinders uptake of treatment among female sex workers and sexually exploited adolescents in Wau and Yambio, South Sudan. BMC Public Health 2023; 23:692. [PMID: 37059971 PMCID: PMC10103365 DOI: 10.1186/s12889-023-15593-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 04/03/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Several factors determine uptake of HIV testing services (HTS) by female sex workers (FSW), including their knowledge of HIV and their awareness of services supporting people who are HIV-positive. HTS provided entry into the UNAIDS 90-90-90 cascade of care. We conducted a cross-sectional biobehavioural survey (BBS) to determine HIV prevalence and progress towards UNAIDS 90-90-90 cascade targets among this population in South Sudan. METHODS Respondent-driven sampling (RDS) was used to recruit women and sexually exploited girls aged 13-18 years who exchanged sex for goods or money in the past 6 months and resided in the town for at least 1 month. Consenting participants were interviewed and tested for HIV and, if positive, they were also tested for their viral load (VL). Data were weighted in RDS Analyst and analyzed with Stata 13. RESULTS A total of 1,284 participants were recruited. The overall HIV cascade coverages were 64.8% aware of their HIV-positive status; 91.0% of those aware of their positive status were on ART; and VL suppression among those on ART was 93.0%. CONCLUSION Being unaware of their HIV-positive status limits, the uptake of HIV treatment among FSW in South Sudan. This underscores the importance of optimized case-finding approaches to increase HTS among FSW and sexually exploited minors.
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Affiliation(s)
- Alex Bolo
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan.
| | | | - Avi J Hakim
- United States Centers for Disease Control and Prevention, DGHT, Atlanta, GA, USA
| | - Joel Katoro
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Sudhir Bunga
- Division of Global HIV and TB (DGHT), United States Centers for Disease Control and Prevention, Juba, South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Juba, South Sudan
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Tuyishime E, Kayitesi C, Musengimana G, Malamba S, Moges H, Kankindi I, Escudero HR, Habimana Kabano I, Oluoch T, Remera E, Chukwu A. Population Size Estimation of Men Who Have Sex With Men in Rwanda: Three-Source Capture-Recapture Method. JMIR Public Health Surveill 2023; 9:e43114. [PMID: 36972131 PMCID: PMC10131990 DOI: 10.2196/43114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/24/2022] [Accepted: 02/03/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Globally, men who have sex with men (MSM) continue to bear a disproportionately high burden of HIV infection. Rwanda experiences a mixed HIV epidemic, which is generalized in the adult population, with aspects of a concentrated epidemic among certain key populations at higher risk of HIV infection, including MSM. Limited data exist to estimate the population size of MSM at a national scale; hence, an important piece is missing in determining the denominators to use in estimates for policy makers, program managers, and planners to effectively monitor HIV epidemic control. OBJECTIVE The aims of this study were to provide the first national population size estimate (PSE) and geographic distribution of MSM in Rwanda. METHODS Between October and December 2021, a three-source capture-recapture method was used to estimate the MSM population size in Rwanda. Unique objects were distributed to MSM through their networks (first capture), who were then tagged according to MSM-friendly service provision (second capture), and a respondent-driven sampling survey was used as the third capture. Capture histories were aggregated in a 2k-1 contingency table, where k indicates the number of capture occasions and "1" and "0" indicate captured and not captured, respectively. Statistical analysis was performed in R (version 4.0.5) and the Bayesian nonparametric latent-class capture-recapture package was used to produce the final PSE with 95% credibility sets (CS). RESULTS We sampled 2465, 1314, and 2211 MSM in capture one, two, and three, respectively. There were 721 recaptures between captures one and two, 415 recaptures between captures two and three, and 422 recaptures between captures one and three. There were 210 MSM captured in all three captures. The total estimated population size of MSM above 18 years old in Rwanda was 18,100 (95% CS 11,300-29,700), corresponding to 0.70% (95% CI 0.4%-1.1%) of total adult males. Most MSM reside in the city of Kigali (7842, 95% CS 4587-13,153), followed by the Western province (2469, 95% CS 1994-3518), Northern province (2375, 95% CS 842-4239), Eastern province (2287, 95% CS 1927-3014), and Southern province (2109, 95% CS 1681-3418). CONCLUSIONS Our study provides, for the first time, a PSE of MSM aged 18 years or older in Rwanda. MSM are concentrated in the city of Kigali and are almost evenly distributed across the other 4 provinces. The national proportion estimate bounds of MSM out of the total adult males includes the World Health Organization's minimum recommended proportion (at least 1.0%) based on 2012 census population projections for 2021. These results will inform denominators to be used for estimating service coverage and fill existing information gaps to enable policy makers and planners to monitor the HIV epidemic among MSM nationally. There is an opportunity for conducting small-area MSM PSEs for subnational-level HIV treatment and prevention interventions.
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Affiliation(s)
- Elysee Tuyishime
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Catherine Kayitesi
- HIV/AIDS, Sexually Transmitted Infections and Viral Hepatitis Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Gentille Musengimana
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Samuel Malamba
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Hailegiorgis Moges
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Ida Kankindi
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Horacio Ruisenor Escudero
- Key Population Surveillance Team, Epidemiology and Surveillance Branch, Division of Global HIV and Tuberculosis, Center of Global Health, US Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Tom Oluoch
- Division of Global HIV and Tuberculosis, Center for Global Health, US Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Eric Remera
- HIV/AIDS, Sexually Transmitted Infections and Viral Hepatitis Division, Rwanda Biomedical Center, Kigali, Rwanda
| | - Angela Chukwu
- African Center of Excellence in Data Science, University of Rwanda, Kigali, Rwanda
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Gutreuter S. Comparative performance of multiple-list estimators of key population size. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000155. [PMID: 35928219 PMCID: PMC9345571 DOI: 10.1371/journal.pgph.0000155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/16/2021] [Indexed: 06/15/2023]
Abstract
Estimates of the sizes of key populations (KPs) affected by HIV, including men who have sex with men, female sex workers and people who inject drugs, are required for targeting epidemic control efforts where they are most needed. Unfortunately, different estimators often produce discrepant results, and an objective basis for choice is lacking. This simulation study provides the first comparison of information-theoretic selection of loglinear models (LLM-AIC), Bayesian model averaging of loglinear models (LLM-BMA) and Bayesian nonparametric latent-class modeling (BLCM) for estimation of population size from multiple lists. Four hundred random samples from populations of size 1,000, 10,000 and 20,000, each including five encounter opportunities, were independently simulated using each of 30 data-generating models obtained from combinations of six patterns of variation in encounter probabilities and five expected per-list encounter probabilities, producing a total of 36,000 samples. Population size was estimated for each combination of sample and sequentially cumulative sets of 2-5 lists using LLM-AIC, LLM-BMA and BLCM. LLM-BMA and BLCM were quite robust and performed comparably in terms of root mean-squared error and bias, and outperformed LLM-AIC. All estimation methods produced uncertainty intervals which failed to achieve the nominal coverage, but LLM-BMA, as implemented in the dga R package produced the best balance of accuracy and interval coverage. The results also indicate that two-list estimation is unnecessarily vulnerable, and it is better to estimate the sizes of KPs based on at least three lists.
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Affiliation(s)
- Steve Gutreuter
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Avery L, Macpherson A, Flicker S, Rotondi M. A review of reported network degree and recruitment characteristics in respondent driven sampling implications for applied researchers and methodologists. PLoS One 2021; 16:e0249074. [PMID: 33857165 PMCID: PMC8049306 DOI: 10.1371/journal.pone.0249074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 03/10/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Respondent driven sampling (RDS) is an important tool for measuring disease prevalence in populations with no sampling frame. We aim to describe key properties of these samples to guide those using this method and to inform methodological research. METHODS In 2019, authors who published respondent driven sampling studies were contacted with a request to share reported degree and network information. Of 59 author groups identified, 15 (25%) agreed to share data, representing 53 distinct study samples containing 36,547 participants across 12 countries and several target populations including migrants, sex workers and men who have sex with men. Distribution of reported network degree was described for each sample and characteristics of recruitment chains, and their relationship to coupons, were reported. RESULTS Reported network degree is severely skewed and is best represented by a log normal distribution. For participants connected to more than 15 other people, reported degree is imprecise and frequently rounded to the nearest five or ten. Our results indicate that many samples contain highly connected individuals, who may be connected to at least 1000 other people. CONCLUSION Because very large reported degrees are common; we caution against treating these reports as outliers. The imprecise and skewed distribution of the reported degree should be incorporated into future RDS methodological studies to better capture real-world performance. Previous results indicating poor performance of regression estimators using RDS weights may be widely generalizable. Fewer recruitment coupons may be associated with longer recruitment chains.
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Affiliation(s)
- Lisa Avery
- Department of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Alison Macpherson
- Department of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Sarah Flicker
- Department of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Michael Rotondi
- Department of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
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Nguyen LT, Patel S, Nguyen NT, Gia HH, Raymond HF, Hoang VTH, Abdul-Quader AS. Population Size Estimation of Female Sex Workers in Hai Phong, Vietnam: Use of Three Source Capture-Recapture Method. J Epidemiol Glob Health 2021; 11:194-199. [PMID: 33876600 PMCID: PMC8242110 DOI: 10.2991/jegh.k.210312.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/07/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction: A study was conducted in three districts in Hai Phong province, Vietnam to estimate the population size of the Female Sex Workers (FSW) in June–July 2019. Methods: The procedures included selection of three districts, compilation of a list of accessible venues where FSW congregate, distribution of first unique objects (first capture) and second unique objects (second capture) to FSW in randomly selected venues and implementation of a Mini-Respondent Driven Sampling (mRDS) Survey (third capture). Population size of the FSW was calculated based on the number of FSW in each round, number of FSW ‘recaptured’ during the second and the third captures. Additionally, personal network size data captured in the mRDS was used to measure the population of FSW within the three districts using Successive Sampling Population Size Estimates (SS-PSE). Results: The total estimated FSWs in the three selected districts, using Three Source Capture–Recapture (3S-CRC) was 958, which is slightly lower than that estimated using SS-PSE – 1192. The 3S-CRC method yielded a provincial estimate of 1911 while the SS-PSE method resulted in a total of 2379 FSW for the province. Conclusion: Two techniques produced different PSE at both the district and the province levels and resulted in estimates lower than ones produced using programmatic data. For planning HIV prevention and care service needs among all FSWs, additional studies are needed to estimate the number of sex workers who are not venue-based and use social media platforms to sell services.
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Affiliation(s)
- Ly Thuy Nguyen
- Division of Global HIV and TB Prevention, Centers for Disease Control and Prevention, Hanoi, Vietnam
| | - Shreya Patel
- The National Cancer Institute, Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, National Institutes of Health, USA
| | - Nga Thi Nguyen
- Department of HIV Surveillance, Monitoring and Evaluation, Provincial HIV/AIDS Control, Hai Phong, Vietnam
| | - Hoa Hoang Gia
- Department of HIV Surveillance, Monitoring and Evaluation, Provincial HIV/AIDS Control, Hai Phong, Vietnam
| | - Henry F Raymond
- Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Piscataway, NJ, USA
| | - Van Thi Hai Hoang
- Department of Global Health, School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Abu S Abdul-Quader
- Division of Global HIV and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Neal JJ, Prybylski D, Sanchez T, Hladik W. Population Size Estimation Methods: Searching for the Holy Grail. JMIR Public Health Surveill 2020; 6:e25076. [PMID: 33270035 PMCID: PMC7746490 DOI: 10.2196/25076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 11/24/2022] Open
Abstract
Accurate size estimates of key populations (eg, sex workers, people who inject drugs, transgender people, and men who have sex with men) can help to ensure adequate availability of services to prevent or treat HIV infection; inform HIV response planning, target setting, and resource allocation; and provide data for monitoring and evaluating program outcomes and impact. A gold standard method for population size estimation does not exist, but quality of estimates could be improved by using empirical methods, multiple data sources, and sound statistical concepts. To highlight such methods, a special collection of papers in JMIR Public Health and Surveillance has been released under the title “Key Population Size Estimations.” We provide a summary of these papers to highlight advances in the use of empirical methods and call attention to persistent gaps in information.
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Affiliation(s)
- Joyce J Neal
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dimitri Prybylski
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Travis Sanchez
- Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Wolfgang Hladik
- Epidemiology and Surveillance Branch, Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Hakim AJ, Bolo A, Werner M, Achut V, Katoro J, Caesar G, Lako R, Taban AI, Wesson J, Okiria AG. High HIV and syphilis prevalence among female sex workers in Juba, South Sudan. PLoS One 2020; 15:e0239543. [PMID: 32986767 PMCID: PMC7521730 DOI: 10.1371/journal.pone.0239543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
HIV prevalence is estimated to be 2.7% in South Sudan; however, little is known about the young country’s epidemic. We conducted a respondent-driven sampling biobehavioral survey in Juba of female sex workers (FSW) aged ≥15 years who sold or exchanged sex in the last 6 months to learn more about this population. We enrolled 838 FSW from November 2015 to March 2016 and estimated HIV prevalence to be 37.8%. Prevalence of active syphilis was 7.3%. FSW were from South Sudan and most neighboring countries. Comprehensive knowledge of HIV was 11.1% and 64.2% of FSW had never spoken with an outreach worker. In multivariable analysis, HIV was associated with being from Uganda (aOR: 3.3, 95% CI: 1.7–6.1) or Kenya (aOR: 4.3, 95% CI: 1.5–13.0) versus from South Sudan. Our survey suggests that FSW may play a critical role in South Sudan’s HIV epidemic and highlights the importance of tailoring services to the unique needs of FSW of all nationalities in Juba.
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Affiliation(s)
- Avi J. Hakim
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Alex Bolo
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Margaret Werner
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | | | - Joel Katoro
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Golda Caesar
- South Sudan Ministry of Health, Juba, South Sudan
| | - Richard Lako
- South Sudan Ministry of Health, Juba, South Sudan
| | | | - Jennifer Wesson
- IntraHealth International, Chapel Hill, NC, United States of America
| | - Alfred G. Okiria
- IntraHealth International, Chapel Hill, NC, United States of America
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Abstract
Purpose of review To explore the comparative importance of HIV infections among key populations and their intimate partners as HIV epidemics evolve, and to review implications for guiding responses. Recent findings Even as concentrated epidemics evolve, new infections among current and former key population members and their intimate partners dominate new infections. Prevalent infections in the general population grow primarily because of key population turnover and infections among their intimate partners. In generalized epidemic settings, data and analysis on key populations are often inadequate to assess the impact of key population-focused responses, so they remain limited in coverage and under resourced. Models must incorporate downstream infections in comparing impacts of alternative responses. Summary Recognize that every epidemic is unique, moving beyond the overly simplistic concentrated/generalized epidemic paradigm that can misdirect resources. Guide HIV responses by gathering and using locally relevant data, understanding risk heterogeneity, and applying modeling at both national and sub-national levels to optimize resource allocations among different populations for greatest impact. Translate this improved understanding into clear, unequivocal advice for policymakers on where to focus for impact, breaking them free of the generalized/concentrated paradigm limiting their thinking and affecting their decisions.
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Manrique-Vallier D. Capture-Recapture Methods for the Social and Medical Sciences. AM STAT 2020. [DOI: 10.1080/00031305.2020.1745574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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