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Katumba KR, Haumba M, Mayanja Y, Machira YW, Gafos M, Quaife M, Seeley J, Greco G. Understanding the contexts in which female sex workers sell sex in Kampala, Uganda: a qualitative study. BMC Womens Health 2024; 24:371. [PMID: 38918714 PMCID: PMC11202390 DOI: 10.1186/s12905-024-03216-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/19/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Structural, interpersonal and individual level factors can present barriers for HIV prevention behaviour among people at high risk of HIV acquisition, including women who sell sex. In this paper we document the contexts in which women selling sex in Kampala meet and provide services to their clients. METHODS We collected qualitative data using semi-structured interviews. Women were eligible to participate if they were 18 years or older, self-identified as sex workers or offered sex for money and spoke Luganda or English. Ten women who met clients in venues and outdoor locations were selected randomly from a clinic for women at high risk of HIV acquisition. Ten other women who met clients online were recruited using snowball sampling. Interviews included demographic data, and themes included reasons for joining and leaving sex work, work locations, nature of relationships with clients and peers, interaction with authorities, regulations on sex work, and reported stigma. We conducted interviews over three months. Data were analysed thematically using a framework analysis approach. The coding framework was based on structural factors identified from literature, but also modified inductively with themes arising from the interviews. RESULTS Women met clients in physical and virtual spaces. Physical spaces included venues and outdoor locations, and virtual spaces were online platforms like social media applications and websites. Of the 20 women included, 12 used online platforms to meet clients. Generally, women from the clinic sample were less educated and predominantly unmarried, while those from the snowball sample had more education, had professional jobs, or were university students. Women from both samples reported experiences of stigma, violence from clients and authorities, and challenges accessing health care services due to the illegality of sex work. Even though all participants worked in settings where sex work was illegal and consequently endured harsh treatment, those from the snowball sample faced additional threats of cybersecurity attacks, extortion from clients, and high levels of violence from clients. CONCLUSIONS To reduce risk of HIV acquisition among women who sell sex, researchers and implementers should consider these differences in contexts, challenges, and risks to design innovative interventions and programs that reach and include all women.
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Affiliation(s)
- Kenneth Roger Katumba
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda.
- London School of Hygiene and Tropical Medicine, London, UK.
| | - Mercy Haumba
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
| | - Yunia Mayanja
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P.O. Box 49, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Mitzy Gafos
- London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew Quaife
- London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- London School of Hygiene and Tropical Medicine, London, UK
| | - Giulia Greco
- London School of Hygiene and Tropical Medicine, London, UK
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Dada D, Abu-Ba'are GR, Turner D, Mashoud IW, Owusu-Dampare F, Apreku A, Ni Z, Djiadeu P, Aidoo-Frimpong G, Zigah EY, Nyhan K, Nyblade L, Nelson LE. Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa. BMJ Open 2024; 14:e078794. [PMID: 38346887 PMCID: PMC10862343 DOI: 10.1136/bmjopen-2023-078794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Sexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas operate and intersect. Intersectional stigma offers a lens for understanding the experiences of stigmatised populations and refers to the synergistic negative health effects of various systems of oppression on individuals with multiple stigmatised identities, behaviours or conditions. This review aims to (1) assess how often and in what ways an intersectional lens is applied in HIV-related stigma research on SGM populations in SSA and (2) understand how intersectional stigma impacts HIV risk in these populations. DESIGN Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. DATA SOURCES Public health and regional databases were searched in 2020 and 2022. ELIGIBILITY CRITERIA Articles in French and English on HIV-related stigma and HIV outcomes among men who have sex with men, women who have sex with women and/or transgender individuals in SSA. DATA EXTRACTION AND SYNTHESIS Articles were screened and extracted twice and categorised by use of an intersectional approach. Study designs and stigma types were described quantitatively and findings on intersectional stigma were thematically analysed. RESULTS Of 173 articles on HIV-related stigma among SGM in SSA included in this review, 21 articles (12%) applied an intersectional lens. The most common intersectional stigmas investigated were HIV and same-sex attraction/behaviour stigma and HIV, same-sex attraction/behaviour and gender non-conformity stigma. Intersectional stigma drivers, facilitators and manifestations were identified across individual, interpersonal, institutional and societal socioecological levels. Intersectional stigma impacts HIV vulnerability by reducing HIV prevention and treatment service uptake, worsening mental health and increasing exposure to HIV risk factors. CONCLUSION Intersectional approaches are gaining traction in stigma research among SGM in SSA. Future research should prioritise quantitative and mixed methods investigations, diverse populations and intervention evaluation.
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Affiliation(s)
- Debbie Dada
- School of Nursing, Yale University, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
| | - Gamji R Abu-Ba'are
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, USA
- Behavioral, Sexual, and Global Health Lab, University of Rochester, Rochester, New York, USA
| | | | | | | | | | - Zhao Ni
- School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Pascal Djiadeu
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
- School of Public Health, University of Toronto Dalla Lana, Toronto, Ontario, Canada
| | - Gloria Aidoo-Frimpong
- Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Edem Yaw Zigah
- Behavioral, Sexual, and Global Health Lab, University of Rochester, Rochester, New York, USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, Connecticut, USA
| | - Laura Nyblade
- Research Triangle Institute, Research Triangle Park, North Carolina, USA
| | - LaRon E Nelson
- School of Nursing, Yale University, New Haven, Connecticut, USA
- St Michael's Hospital Centre for Urban Health Solutions, Toronto, Ontario, Canada
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Jones HS, Anderson RL, Cust H, McClelland RS, Richardson BA, Thirumurthy H, Malama K, Hensen B, Platt L, Rice B, Cowan FM, Imai-Eaton JW, Hargreaves JR, Stevens O. HIV incidence among women engaging in sex work in sub-Saharan Africa: a systematic review and meta-analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.17.23297108. [PMID: 37905066 PMCID: PMC10615019 DOI: 10.1101/2023.10.17.23297108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Introduction HIV incidence among women in sub-Saharan Africa (SSA) has declined steadily, but it is unknown whether new infections among women who engage in sex work (WESW) have declined at a similar rate. We synthesised estimates of HIV incidence among WESW in SSA and compared these to the wider female population to understand levels and trends in incidence over time. Methods We searched Medline, Embase, Global Health, Popline, Web of Science, and Google Scholar from January 1990 to October 2022, and grey literature for estimates of HIV incidence among WESW in SSA. We included studies reporting empirical estimates in any SSA country. We calculated incidence rate ratios (IRR) compared to age-district-year matched total female population incidence estimates. We conducted a meta-analysis of IRRs and used a continuous mixed-effects model to estimate changes in IRR over time. Results From 32 studies between 1985 and 2020, 2,194 new HIV infections were observed in WESW over 51,000 person-years (py). Median HIV incidence was 4.3/100py (IQR 2.8-7.0/100py), declining from a median of 5.96/100py between 1985 and 1995 to a median of 3.2/100py between 2010 and 2020. Incidence among WESW was nine times higher than in matched total population women (RR 8.6, 95%CI: 5.7-12.9), and greater in Western and Central Africa (RR 22.4, 95%CI: 11.3-44.3) than in Eastern and Southern Africa (RR 5.3, 95%CI: 3.7-7.6). Annual changes in log IRRs were minimal (-0.1% 95%CI: -6.9 to +6.8%). Conclusions Across SSA, HIV incidence among WESW remains disproportionately high compared to the total female population but showed similar rates of decline between 1990 and 2020. Improved surveillance and standardisation of approaches to obtain empirical estimates of sex worker incidence would enable a clearer understanding of whether we are on track to meet global targets for this population and better support data-driven HIV prevention programming.
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Affiliation(s)
- Harriet S Jones
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rebecca L Anderson
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Henry Cust
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - R Scott McClelland
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Department of Biostatistics, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kalonde Malama
- University of Toronto Factor-Inwentash Faculty of Social Work, Toronto Ontario, Canada
| | - Bernadette Hensen
- Sexual and Reproductive Health Group, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Rice
- Sheffield Centre for Health and Related Research (SCHARR); School of Medicine and Population Health, University of Sheffield, UK
| | - Frances M Cowan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Sexual Health and HIV/AIDS Research Zimbabwe, Harare, Zimbabwe
| | - Jeffrey W Imai-Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - James R Hargreaves
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver Stevens
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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Grosso A, Fielding-Miller R, Matse S, Sithole B, Baral S. The relationship between underage initiation of selling sex and depression among female sex workers in Eswatini. Front Psychiatry 2023; 14:1048703. [PMID: 37435406 PMCID: PMC10331471 DOI: 10.3389/fpsyt.2023.1048703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
Background Minors who sell sex are likely to have complex mental health needs that may persist into adulthood. This topic is understudied in sub-Saharan Africa. This study hypothesized that adult female sex workers in Eswatini who started selling sex as minors have a higher prevalence of depression than those who started as adults. We also examined correlates of depression and underage initiation of selling sex, including stigma and condom-related behaviors. Methods From October-December 2014, women aged 18 or older who sold sex in the past 12 months in Eswatini were recruited through venue-based sampling. Participants completed a survey including the 9-item Patient Health Questionnaire (PHQ-9) and a question about the age at which they first sold sex for money. T-tests, χ2 tests and multivariable logistic regression were used to assess associations. Results Overall, 43.1% of participants (332/770) had probable depression, and 16.6% (128/770) started selling sex as minors under the age of 18. Over half (55.5%, 71/128) of those who started selling sex as minors had depression. This was significantly higher than the 40.7% (261/642) prevalence of depression among participants who started selling sex as adults (p = 0.002). After adjusting for confounders, female sex workers who started selling sex as minors had higher odds of depression than those who started as adults (adjusted odds ratio [aOR] 1.70, 95% confidence interval 1.11-2.60). Conclusion Results highlight the need for trauma-informed and adolescent-friendly mental health services in settings free of stigma toward female sex workers in Eswatini.
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Affiliation(s)
- Ashley Grosso
- Center for Population Behavioral Health, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ, United States
- Department of Urban-Global Public Health, Rutgers School of Public Health, Newark, NJ, United States
| | - Rebecca Fielding-Miller
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego, CA, United States
| | | | - Bhekie Sithole
- Health Communication Capacity Collaborative, Mbabane, Eswatini
| | - Stefan Baral
- Department of Epidemiology, Key Populations Program, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Migowa A, Bernatsky S, Ngugi A, Foster HE, Muriuki P, Lusambili A, Luchters S. An iceberg I can't handle: a qualitative inquiry on perceptions towards paediatric rheumatology among healthcare workers in Kenya. Pediatr Rheumatol Online J 2023; 21:6. [PMID: 36681840 PMCID: PMC9862847 DOI: 10.1186/s12969-023-00790-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/15/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Delay in diagnosis and access to specialist care is a major problem for many children and young people with rheumatic disease in sub-Saharan Africa. Most children with symptoms of rheumatic disease present to non-specialists for care. There is an urgent need to understand and scale-up paediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management. PURPOSE We evaluated the knowledge, attitudes and practices towards diagnosis and care of paediatric rheumatology patients among health care workers in Kenya. METHODS We conducted 12 focus group discussions with clinical officers (third-tier community health workers) nurses, general practitioners and paediatricians across 6 regions in Kenya. Interviews were conducted on zoom, audio-recorded, transcribed, and analysed using NVIVO software. RESULTS A total of 68 individuals participated; 11 clinical officers, 12 nurses, 10 general practitioners, 27 paediatricians and 7 others. Most (n = 53) were female, and the median age was 36 years (range 31-40 years). Fifty per cent of the participants (34 of 68) worked in public health facilities. Our study revealed gaps in knowledge of paediatric rheumatology amongst healthcare workers which contributes to delayed diagnosis and poor management. Healthcare workers reported both positive and negative attitudes towards diagnosis and care of paediatric rheumatology patients. Perceived complexity and lack of knowledge in diagnosis, management and lack of health system clinical pathways made all cadres of healthcare workers feel helpless, frustrated, inadequate and incompetent to manage paediatric rheumatology patients. Positive attitudes arose from a perceived feeling that paediatric rheumatology patients pose unique challenges and learning opportunities. CONCLUSION There is an urgent need to educate healthcare workers and improve health systems to optimize clinical care for paediatric rheumatology patients.
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Affiliation(s)
- Angela Migowa
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. .,Department of Paediatrics and Child Health, Aga Khan University, Medical College East Africa, Nairobi, Kenya.
| | - Sasha Bernatsky
- grid.63984.300000 0000 9064 4811Department of Medicine (Division of Rheumatology and Epidemiology) McGill University Health Centre (MUCH), Montreal, Canada
| | - Anthony Ngugi
- grid.470490.eDepartment of Population Health, Aga Khan University East Africa, Nairobi, Kenya
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Population and Health Institute, Newcastle University, Newcastle, UK
| | - Peter Muriuki
- grid.413355.50000 0001 2221 4219African Population and Health Research Centre, Nairobi, Kenya
| | - Adelaide Lusambili
- grid.470490.eDepartment of Population Health, Aga Khan University East Africa, Nairobi, Kenya
| | - Stanley Luchters
- grid.5342.00000 0001 2069 7798International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ,grid.463169.f0000 0004 9157 2417Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe ,grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
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Caballero-Hoyos R, Monárrez-Espino J, Ramírez-Ortíz MG, Cárdenas-Medina FM. Factors Associated with Unprotected Anal Sex among Men Who Have Sex with Men in Mexico. Infect Dis Rep 2022; 14:547-557. [PMID: 35893477 PMCID: PMC9326714 DOI: 10.3390/idr14040058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 02/04/2023] Open
Abstract
The global prevalence of HIV is notably higher in men who have sex with men (MSM) compared with other male populations. Unprotected anal intercourse is the riskiest sexual behavior for HIV acquisition and/or transmission among this minority population. The purpose of the study was to identify if the syndemic of psychosocial stressors and experienced stigma are predictors of unprotected anal sex in Mexican MSM. A cross-sectional analytic study was carried out. It included adults residing in Manzanillo, Mexico, with oral/anal sex practices within the last year. Informed consent was given by 142 participants selected using snowball sampling. Collected data included sociodemographic characteristics, psychosocial stressors, experienced stigma, HIV knowledge, knowing a friend/acquaintance living with HIV/AIDS, and sexual risk behaviors. Adjusted logistic regression was used to identify predictors of unprotected anal sex within the last six months. Presence of syndemic of psychosocial stressors, drug use during sex, having friends/acquaintances with HIV/AIDS, and experiencing high stigma were positively associated; high level of HIV knowledge was negatively linked. Reducing psychosocial stressors and integrating stigma-mitigation strategies are key elements to reduce HIV transmission.
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Affiliation(s)
- Ramiro Caballero-Hoyos
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Colima 28040, Mexico;
| | - Joel Monárrez-Espino
- Department of Health Research, Christus Muguerza del Parque Hospital, University of Monterrey, Chihuahua 31000, Mexico
- Medicine and Health Sciences Unit, Zacatecas Autonomous University, Zacatecas 98000, Mexico
- Correspondence:
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Hulstein SH, Zimmermann HM, de la Court F, Matser AA, Schim van der Loeff MF, Hoornenborg E, Davidovich U, Prins M, de Vries HJ. Factors Associated With the Intention to Use HIV Preexposure Prophylaxis for Young and Older Men Who Have Sex With Men. Sex Transm Dis 2022; 49:343-352. [PMID: 35001016 PMCID: PMC8994038 DOI: 10.1097/olq.0000000000001599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The uptake of preexposure prophylaxis (PrEP) against HIV is low among young men who have sex with men (MSM) in the Netherlands. Studying the intention to use PrEP among non-PrEP using young and older MSM can guide health authorities in developing new prevention campaigns to optimize PrEP uptake. METHODS We investigated the sociodemographic, behavioral, and psychosocial factors associated with a high PrEP use intention in the coming 6 months among 93 young MSM (aged ≤25 years), participating in an online survey, and 290 older MSM (aged ≥26 years), participating in an open, prospective cohort in 2019 to 2020. RESULTS Perceiving PrEP as an important prevention tool was associated with a high PrEP use intention among young and older MSM. Among young MSM, a high level of PrEP knowledge and believing that PrEP users take good care of themselves and others were associated with a high PrEP use intention. Among older MSM, 2 or more anal sex partners, chemsex, high HIV risk perception, and believing PrEP increases sexual pleasure were associated with a high PrEP use intention. Believing PrEP leads to adverse effects was associated with a low intention to use PrEP among older MSM. CONCLUSIONS To conclude, we showed that both behavioral and psychosocial factors were associated with a high PrEP use intention among young and older MSM. In addition to focusing on sexual behavior and HIV risk, future prevention campaigns and counseling on PrEP could incorporate education, endorsing positive beliefs, and disarming negative beliefs to improve the uptake of PrEP in young and older MSM.
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Affiliation(s)
| | | | - Feline de la Court
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Amy A. Matser
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam
| | - Maarten F. Schim van der Loeff
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam
| | - Elske Hoornenborg
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Udi Davidovich
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Maria Prins
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam
| | - Henry J.C. de Vries
- Department of Dermatology, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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Evaluating the quality of HIV epidemiologic evidence for populations in the absence of a reliable sampling frame: a modified quality assessment tool. Ann Epidemiol 2022; 65:78-83. [PMID: 34314845 PMCID: PMC8748278 DOI: 10.1016/j.annepidem.2021.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/16/2021] [Accepted: 07/18/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Sampling frames rarely exist for key populations at highest risk for HIV, such as sex workers, men who have sex with men, people who use drugs, and transgender populations. Without reliable sampling frames, most data collection relies on non-probability sampling approaches including network-based methods (e.g. respondent driven sampling) and venue-based methods (e.g. time-location sampling). Quality of implementation and reporting of these studies is highly variable, making wide-ranging estimates often difficult to compare. Here, a modified quality assessment tool, Global.HIV Quality Assessment Tool for Data Generated through Non-Probability Sampling (GHQAT), was developed to evaluate the quality of HIV epidemiologic evidence generated using non-probability methods. METHODS The GHQAT assesses three main domains: study design, study implementation, and indicator-specific criteria(prevalence, incidence, HIV continuum of care, and population size estimates). The study design domain focuses primarily on the specification of the target and study populations. The study implementation domain is concerned with sampling implementation. Each indicator-specific section contains items relevant to that specific indicator. A random subset of 50 studies from a larger systematic review on epidemiologic data related to HIV and key populations was generated and reviewed using the GHQAT by two independent reviewers. Inter-rater reliability was assessed by calculating intraclass correlation coefficients for the scores assigned to study design, study implementation and each of the indicator-specific criteria. Agreement was categorized as poor(0.00-0.50), fair(0.51-0.70), and good(0.71-1.00). The distribution of good, fair, and poor scores for each section was described. RESULTS Overall, agreement between the two independent reviewers was good(ICC >0.7). Agreement was best for the section evaluating the HIV continuum of care(ICC = 0.96). For HIV incidence, perfect agreement was observed, but this is likely due to the small number of studies reviewed that assessed incidence(n = 3). Of the studies reviewed, 2% (n = 1) received a score of "poor" for study design, while 50% (n = 25) received a score of "poor" for study implementation. CONCLUSIONS Addressing HIV prevention and treatment needs of key populations is increasingly understood to be central to HIV responses across HIV epidemic settings, though data characterizing specific needs remains highly variable with the least amount of information in the most stigmatizing settings. Here, we present an efficient tool to guide HIV prevention and treatment programs as well as epidemiological data collection by reliably synthesizing the quality of available non-probability based epidemiologic information for key populations. This tool may help shed light on how researchers may improve not only the implementation of, but also the reporting on their studies.
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Wiginton JM, Murray SM, Poku O, Augustinavicius J, Jackman KMP, Kane J, Billong SC, Diouf D, Ba I, Mothopeng T, Njindam IM, Turpin G, Tamoufe U, Sithole B, Zlotorzynska M, Sanchez TH, Baral SD. Disclosure of same-sex practices and experiences of healthcare stigma among cisgender men who have sex with men in five sub-Saharan African countries. BMC Public Health 2021; 21:2206. [PMID: 34861835 PMCID: PMC8641177 DOI: 10.1186/s12889-021-12151-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/28/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND For men who have sex with men (MSM) across sub-Saharan Africa (SSA), disclosure of same-sex practices to family and healthcare workers (HCWs) can facilitate access to HIV prevention services and support, but can also lead to experiences of stigma. METHODS We performed mixed-effects regressions on pooled data from MSM in Cameroon, Senegal, Côte d'Ivoire, Lesotho, and eSwatini to assess associations between disclosure and sexual behavior stigma in healthcare contexts; we used logistic regressions to analyze country-specific data. RESULTS Compared to participants who had not disclosed to either family or HCWs, those who had disclosed only to family were more likely to have been gossiped about by HCWs (aOR = 1.70, CI = 1.18, 2.45); the association between having disclosed to family and having felt mistreated in a health center approached, but did not achieve, statistical significance (aOR = 1.56, CI = 0.94, 2.59). Those who had disclosed only to HCWs were more likely to have feared to seek health services (aOR = 1.60, CI = 1.14, 2.25), avoided health services (aOR = 1.74, CI = 1.22, 2.50), and felt mistreated in a health center (aOR = 2.62, CI = 1.43, 4.81). Those who had disclosed to both were more likely to have feared to seek health services (aOR = 1.71, CI = 1.16, 2.52), avoided health services (aOR = 1.59, CI = 1.04, 2.42), been gossiped about by HCWs (aOR = 3.78, CI = 2.38, 5.99), and felt mistreated in a health center (aOR = 3.39, CI = 1.86, 6.20). Country-specific analyses suggested that data from Cameroon drove several of these associations. CONCLUSIONS Research to determine the factors driving disclosure's differential effect on healthcare stigma across contexts is needed. Ultimately, supportive environments enabling safe disclosure is critical to understanding HIV-acquisition risks and informing differentiated HIV-prevention, treatment, and testing services for MSM across SSA.
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Affiliation(s)
- John Mark Wiginton
- grid.21107.350000 0001 2171 9311Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD 21205 USA
| | - Sarah M. Murray
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Ohemaa Poku
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Jura Augustinavicius
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Kevon-Mark Phillip Jackman
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
| | - Jeremy Kane
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, NY USA
| | - Serge C. Billong
- grid.412661.60000 0001 2173 8504Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon; Central Technical Group, National AIDS Control Committee, Yaoundé, Cameroon
| | | | | | | | - Iliassou Mfochive Njindam
- grid.21107.350000 0001 2171 9311Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.452492.cMetabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Gnilane Turpin
- grid.21107.350000 0001 2171 9311Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA ,grid.452492.cMetabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | - Ubald Tamoufe
- grid.452492.cMetabiota, Yaounde, Cameroon, Johns Hopkins Cameroon Program, Yaounde, Cameroon
| | | | - Maria Zlotorzynska
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Travis H. Sanchez
- grid.189967.80000 0001 0941 6502Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
| | - Stefan D. Baral
- grid.21107.350000 0001 2171 9311Center for Public Health & Human Rights, Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD USA
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10
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El-Khechen HA, Khan MIU, Leenus S, Olaiya O, Durrani Z, Masood Z, Leenus A, Akhter S, Mbuagbaw L. Design, analysis, and reporting of pilot studies in HIV: a systematic review and methodological study. Pilot Feasibility Stud 2021; 7:211. [PMID: 34847957 PMCID: PMC8630899 DOI: 10.1186/s40814-021-00934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/22/2021] [Indexed: 11/12/2022] Open
Abstract
Background Pilot studies are essential in determining if a larger study is feasible. This is especially true when targeting populations that experience stigma and may be difficult to include in research, such as people with HIV. We sought to describe how pilot studies have been used to inform HIV clinical trials. Methods We conducted a methodological study of pilot studies of interventions in people living with HIV published until November 25, 2020, using Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL). We extracted data on their nomenclature, primary objective, use of progression criteria, sample size, use of qualitative methods, and other contextual information (region, income, level, type of intervention, study design). Results Our search retrieved 10,597 studies, of which 248 were eligible. The number of pilot studies increased steadily over time. We found that 179 studies (72.2%) used the terms “pilot” or “feasibility” in their title, 65.3% tested feasibility as a primary objective, only 2% used progression criteria, 23.9% provided a sample size estimation and only 30.2% used qualitative methods. Conclusions Pilot studies are increasingly being used to inform HIV research. However, the titles and objectives are not always consistent with piloting. The design and reporting of pilot studies in HIV could be improved. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-021-00934-9.
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Affiliation(s)
- Hussein Ali El-Khechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.
| | - Mohammed Inam Ullah Khan
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Selvin Leenus
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Oluwatobi Olaiya
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Zoha Durrani
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, USA
| | - Zaryan Masood
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Alvin Leenus
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Shakib Akhter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, Ontario, Canada.,Center for the Development of Best Practices in Health, Yaoundé, Cameroon
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11
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Alarmingly High HIV Prevalence Among Adolescent and Young Men Who have Sex with Men (MSM) in Urban Indonesia. AIDS Behav 2021; 25:3687-3694. [PMID: 34143341 PMCID: PMC8560664 DOI: 10.1007/s10461-021-03347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/23/2022]
Abstract
Indonesia’s HIV epidemic is concentrated among key populations. While prevalence among men who have sex with men (MSM) is high, transmission among young MSM (15–24-years-old) remains poorly understood. We conducted a respondent driven sampling survey of 211 young MSM in urban Bandung, Indonesia in 2018–2019 to estimate HIV prevalence and associated risk factors. Thirty percent of young MSM were HIV antibody positive. This is nearly 100-fold greater than Indonesia’s population prevalence and sevenfold higher than average estimates for young MSM across Asia and the Pacific Region. Individual risk factors associated with HIV infection were being 20–24 years old, having a steady partner and preferring the receptive position during sex. Issues of stigma, discrimination and social exclusion were common. Few young MSM who were open with friends and family members about their sexual identity. Among those that were, close to half reported experiencing feelings of aversion from these groups. Wider structural factors that reduce social tolerance, restrict the rights of young MSM and compel concealment of sexual identity are likely to fuel high-risk behaviors and limit access to essential testing care and support services including pre-exposure prophylaxis which is not yet widely available. Urgent health, social, legal and political actions are required to respond to these factors and reduce the disproportionate contribution of young MSM to Indonesia’s HIV epidemic.
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12
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Irvin R, Gamble T, Malone J, Wang Z, Wilson E, Hughes JP, Farley J, Mayer KH, Del Rio C, Batey DS, Cummings V, Remien RH, Beyrer C, Thio CL. HIV Prevention Trials Network 078: High Prevalence of Hepatitis C Virus Antibodies Among Urban US Men Who Have Sex With Men, Independent of Human Immunodeficiency Virus Status. Clin Infect Dis 2021; 73:e2205-e2210. [PMID: 33346798 PMCID: PMC8492204 DOI: 10.1093/cid/ciaa1869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sexual transmission of hepatitis C virus (HCV) is uncommon, yet documented among men who have sex with men (MSM), primarily among those with human immunodeficiency virus (HIV). METHODS In the HIV Prevention Trials Network 078 study (HPTN 078), which assessed an integrated strategy to achieve HIV viral suppression, 1305 MSM were screened across 4 geographically diverse US cities. At screening, demographic/behavioral/psychosocial questionnaires were completed, along with HIV and HCV testing. Multivariable logistic regression was used to evaluate associations with HCV antibody positivity. RESULTS Among the 1287 (99%) of the MSM with HCV antibody results, the median age was 41, 69% were black, 85% had a high school education or more, 35% were employed, 70% had HIV, and 21% had undergone substance use counseling. The median lifetime number of male sexual partners was 17 (interquartile range, 6-50), and 246 (19%) were HCV antibody positive. HCV antibody positivity was high in MSM with HIV (20%) and MSM without HIV (17%) (P = .12) and was higher in those receiving substance use counseling (36%) than in those who had not (15%) (P ≤ .01). Substance use counseling (odds ratio, 2.51; 95% confidence interval, 1.80-3.51) and unstable housing (2.16; 1.40-3.33) were associated with HCV antibody positivity. CONCLUSIONS Nearly 1 in 5 MSM screened for HPTN 078 have been infected with HCV. The prevalence is high regardless of HIV status and is high even in those who did not undergo substance use counseling. In HIV burden networks, high HCV infection prevalence may occur in MSM without HIV. As implementation of preexposure prophylaxis expands and condom use declines, routine HCV counseling and screening among MSM are important.
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Affiliation(s)
- Risha Irvin
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Theresa Gamble
- HPTN Leadership and Operations Center, FHI 360, Durham, North Carolina, USA
| | | | - Zhe Wang
- Statistical Center for HIV/AIDS Research and Prevention, Seattle, Washington , USA
| | - Ethan Wilson
- Statistical Center for HIV/AIDS Research and Prevention, Seattle, Washington , USA
| | | | - Jason Farley
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Kenneth H Mayer
- The Fenway Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Del Rio
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - D Scott Batey
- The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Chris Beyrer
- Johns Hopkins University, Baltimore, Maryland, USA
| | - Chloe L Thio
- Johns Hopkins University, Baltimore, Maryland, USA
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13
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Long LC, Rosen S, Nichols B, Larson BA, Ndlovu N, Meyer‐Rath G. Getting resources to those who need them: the evidence we need to budget for underserved populations in sub-Saharan Africa. J Int AIDS Soc 2021; 24 Suppl 3:e25707. [PMID: 34189873 PMCID: PMC8242975 DOI: 10.1002/jia2.25707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/09/2022] Open
Abstract
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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Affiliation(s)
- Lawrence C Long
- Department of Global HealthSchool of Public HealthBoston UniversityBostonMAUSA
- Department of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
- Health Economics and Epidemiology Research OfficeWits Health ConsortiumJohannesburgSouth Africa
| | - Sydney Rosen
- Department of Global HealthSchool of Public HealthBoston UniversityBostonMAUSA
- Department of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
- Health Economics and Epidemiology Research OfficeWits Health ConsortiumJohannesburgSouth Africa
| | - Brooke Nichols
- Department of Global HealthSchool of Public HealthBoston UniversityBostonMAUSA
- Department of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
- Health Economics and Epidemiology Research OfficeWits Health ConsortiumJohannesburgSouth Africa
| | - Bruce A Larson
- Department of Global HealthSchool of Public HealthBoston UniversityBostonMAUSA
- Department of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
- Health Economics and Epidemiology Research OfficeWits Health ConsortiumJohannesburgSouth Africa
| | - Nhlanhla Ndlovu
- Centre for Economic Governance and Accountability in Africa (CEGAA)PietermaritzburgSouth Africa
| | - Gesine Meyer‐Rath
- Department of Global HealthSchool of Public HealthBoston UniversityBostonMAUSA
- Department of Internal MedicineSchool of Clinical MedicineFaculty of Health SciencesUniversity of WitwatersrandJohannesburgSouth Africa
- Health Economics and Epidemiology Research OfficeWits Health ConsortiumJohannesburgSouth Africa
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14
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Niu XM, Rao A, Chen D, Sheng B, Weir S, Umar E, Trapence G, Jumbe V, Kamba D, Rucinski K, Viswasam N, Baral S, Bao L. Using factor analyses to estimate the number of female sex workers across Malawi from multiple regional sources. Ann Epidemiol 2020; 55:34-40. [PMID: 33340655 DOI: 10.1016/j.annepidem.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 11/03/2020] [Accepted: 12/02/2020] [Indexed: 01/27/2023]
Abstract
PURPOSE Human immunodeficiency virus (HIV) risks are heterogeneous in nature even in generalized epidemics. However, data are often missing for those at highest risk of HIV, including female sex workers. Statistical models may be used to address data gaps where direct, empiric estimates do not exist. METHODS We proposed a new size estimation method that combines multiple data sources (the Malawi Biological and Behavioral Surveillance Survey, the Priorities for Local AIDS Control Efforts study, and the Malawi Demographic Household Survey). We used factor analysis to extract information from auxiliary variables and constructed a linear mixed effects model for predicting population size for all districts of Malawi. RESULTS On average, the predicted proportion of female sex workers among women of reproductive age across all districts was about 0.58%. The estimated proportions seemed reasonable in comparing with a recent study Priorities for Local AIDS Control Efforts II (PLACE II). Compared with using a single data source, we observed increased precision and better geographic coverage. CONCLUSIONS We illustrate how size estimates from different data sources may be combined for prediction. Applying this approach to other subpopulations in Malawi and to countries where size estimate data are lacking can ultimately inform national modeling processes and estimate the distribution of risks and priorities for HIV prevention and treatment programs.
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Affiliation(s)
- Xiaoyue Maggie Niu
- Department of Statistics, Eberly College of Science, Pennsylvania State University, University Park
| | - Amrita Rao
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - David Chen
- Department of Statistics, Eberly College of Science, Pennsylvania State University, University Park
| | - Ben Sheng
- Department of Statistics, Eberly College of Science, Pennsylvania State University, University Park
| | - Sharon Weir
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Eric Umar
- Department of Health Systems and Policy, School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | | | - Vincent Jumbe
- Department of Health Systems and Policy, School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Dunker Kamba
- Center for Development of People, Blantyre, Malawi
| | - Katherine Rucinski
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Nikita Viswasam
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Le Bao
- Department of Statistics, Eberly College of Science, Pennsylvania State University, University Park.
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15
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Matchanova A, Babicz MA, Medina LD, Rahman S, Johnson B, Thompson JL, Beltran-Najera I, Brooks J, Sullivan KL, Walker RL, Podell K, Woods SP. Latent Structure of a Brief Clinical Battery of Neuropsychological Tests Administered In-Home Via Telephone. Arch Clin Neuropsychol 2020; 36:874-886. [DOI: 10.1093/arclin/acaa111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objective
To examine the factor structure and sociodemographic correlates of a battery of clinical neuropsychological tests administered in-home and via telephone.
Method
Participants included 280 healthy adults who completed a 35–40 min battery consisting of seven auditory-verbal neuropsychological tests (i.e., 10 variables) that included digit span, list learning and memory, prospective memory, verbal fluency, and oral trail making.
Results
After removing oral trail making part A, a three-factor model comprised of executive functions, memory and attention demonstrated the best fit to the data. Nevertheless, the shared variance between the nine remaining neuropsychological variables was also adequately explained by a single-factor model and a two-factor model comprised of executive functions and memory. Factor scores were variably associated with education, race/ethnicity, and IQ, but not with sex or age.
Conclusions
Findings provide preliminary support for the feasibility and factor structure and sociodemographic correlates of a brief telephone-based screening neuropsychological battery comprised mostly of commonly administered clinical measures. Future studies are needed to determine the test–retest reliability, sensitivity, and ecological relevance of this battery, as well as equivalency to in-person assessment.
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Affiliation(s)
| | - Michelle A Babicz
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Luis D Medina
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Samina Rahman
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Briana Johnson
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | | | | | - Jasmin Brooks
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Kelli L Sullivan
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Rheeda L Walker
- Department of Psychology, University of Houston, Houston, TX 77002, USA
| | - Kenneth Podell
- Department of Neurology, Methodist Hospital, Houston, TX 77030, USA
| | - Steven Paul Woods
- Department of Psychology, University of Houston, Houston, TX 77002, USA
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16
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Sandfort TGM, L Hamilton E, Marais A, Guo X, Sugarman J, Chen YQ, Cummings V, Dadabhai S, Dominguez K, Panchia R, Schnabel D, Zulu F, Reynolds D, Radebe O, Mbeda C, Kamba D, Kanyemba B, Ogendo A, Stirratt M, Chege W, Lucas J, Fawzy M, McKinstry LA, Eshleman SH. The feasibility of recruiting and retaining men who have sex with men and transgender women in a multinational prospective HIV prevention research cohort study in sub-Saharan Africa (HPTN 075). J Int AIDS Soc 2020; 23 Suppl 6:e25600. [PMID: 33000911 PMCID: PMC7527761 DOI: 10.1002/jia2.25600] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/30/2020] [Accepted: 07/21/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa (SSA) are profoundly affected by HIV with high HIV prevalence and incidence. This population also faces strong social stigma and legal barriers, potentially impeding participation in research. To date, few multi-country longitudinal HIV research studies with MSM/TGW have been conducted in SSA. Primary objective of the HIV Prevention Trials Network (HPTN) 075 study was to assess feasibility of recruiting and retaining a multinational prospective cohort of MSM/TGW in SSA for HIV prevention research. METHODS HPTN 075, conducted from 2015 to 2017, was designed to enroll 400 MSM/TGW at four sites in SSA (100 per site: Kisumu, Kenya; Blantyre, Malawi; Cape Town, South Africa; and Soweto, South Africa). The number of HIV-positive persons was capped at 20 per site; HIV-positive persons already in care were excluded from participation. The one-year study included five biobehavioural assessments. Community-based input and risk mitigation protocols were included in study design and conduct. RESULTS Of 624 persons screened, 401 were enrolled. One in five participants was classified as transgender. Main reasons for ineligibility included: (a) being HIV positive after the cap was reached (29.6%); (b) not reporting anal intercourse with a man in the preceding three months (20.6%); and (c) being HIV positive and already in care (17.5%). Five (1.2%) participants died during the study (unrelated to study participation). 92.9% of the eligible participants (368/396) completed the final study visit and 86.1% participated in all visits. The main, overlapping reasons for early termination included being (a) unable to adhere to the visit schedule, predominantly because of relocation (46.4%), and (b) unable to contact the participant (32.1%). Participants reported strong motivation to participate and few participation barriers. Four participants reported social harms (loss of confidentiality and sexual harassment by study staff) that were successfully addressed. CONCLUSIONS HPTN 075 successfully enrolled a multinational sample of MSM/TGW in SSA in a prospective HIV prevention research study with a high retention rate and few documented social harms. This supports the feasibility of conducting large-scale research trials in this population to address its urgent, unmet HIV prevention needs.
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Affiliation(s)
- Theodorus GM Sandfort
- HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute and Columbia UniversityNew YorkNYUSA
| | | | - Anita Marais
- Perinatal HIV Research UnitUniversity of the WitwatersrandSoweto HPTN CRSSowetoSouth Africa
| | - Xu Guo
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Jeremy Sugarman
- Berman Institute of BioethicsJohns Hopkins UniversityBaltimoreMDUSA
| | - Ying Q Chen
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Vanessa Cummings
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
| | - Sufia Dadabhai
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBlantyreMalawi
| | - Karen Dominguez
- Desmond Tutu HIV CentreUCT Medical SchoolCape TownSouth Africa
| | - Ravindre Panchia
- Perinatal HIV Research UnitUniversity of the WitwatersrandSoweto HPTN CRSSowetoSouth Africa
| | | | - Fatima Zulu
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBlantyreMalawi
| | | | | | - Calvin Mbeda
- Kenya Medical Research Institute (KEMRI) CDCKisumuKenya
| | - Dunker Kamba
- Centre for the Development of People (CEDEP)BlantyreMalawi
| | - Brian Kanyemba
- Desmond Tutu HIV CentreUCT Medical SchoolCape TownSouth Africa
| | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDCKisumuKenya
| | - Michael Stirratt
- Division of AIDS ResearchNational Institute of Mental HealthBethesdaMDUSA
| | - Wairimu Chege
- Division of AIDNational Institute of Allergy and Infectious DiseaseNational Institutes of HealthBethesdaMDUSA
| | | | | | - Laura A McKinstry
- Vaccine and Infectious Disease DivisionFred Hutchinson Cancer Research CenterSeattleWAUSA
| | - Susan H Eshleman
- Department of PathologyJohns Hopkins University School of MedicineBaltimoreMDUSA
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Datta A, Pita A, Rao A, Sithole B, Mnisi Z, Baral S. Size estimation of key populations in the HIV epidemic in eSwatini using incomplete and misaligned capture-recapture data. Ann Appl Stat 2020. [DOI: 10.1214/20-aoas1327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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HIV-Related Implementation Research for Key Populations: Designing for Individuals, Evaluating Across Populations, and Integrating Context. J Acquir Immune Defic Syndr 2020; 82 Suppl 3:S206-S216. [PMID: 31764256 DOI: 10.1097/qai.0000000000002191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Key populations, including men who have sex with men, transgender people, sex workers, people who inject drugs, and incarcerated populations, experience high burdens of HIV and urgently need effective interventions. Yet the evidence base for implementation research (IR) with key populations remains weak and poses specific challenges to epidemiologic inference. We apply the Consolidated Framework for IR to consider specific challenges and recommendations for IR with key populations. DISCUSSION Individuals within key populations exist within inner and outer settings-including organizational structures, legal (eg, criminalization), and funding environments-which influence the design, adoption and fidelity of interventions, and the potential sustainability of intervention scale-up. Underlying vulnerabilities and external stressors experienced at the individual level (eg, homelessness, violence) further impact participation and retention in IR. Thus, researchers should account for representation in the research process, beginning with community engagement in IR design and consideration of enumeration/sampling methods for key populations who lack probabilistic sampling frames. Interventions for key populations require substantial adaptation and complexity (eg, individually tailored, multicomponent) to ensure appropriateness; however, there is tension between the need for complexity and challenges to internal validity (fidelity) and external validity (generalizable scale-up). Finally, integrating contextual, sampling, and implementation elements into analytic approaches is critical for effectiveness evaluation. CONCLUSIONS Translation of efficacious findings at the individual level to effectiveness at the population level requires recognition of risk heterogeneity. Recognizing the nuances of working with key populations is essential to ensure that individuals are represented by design and therefore gains in population health can be achieved.
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Jennings Mayo-Wilson L, Mathai M, Yi G, Mak’anyengo MO, Davoust M, Massaquoi ML, Baral S, Ssewamala FM, Glass NE. Lessons learned from using respondent-driven sampling (RDS) to assess sexual risk behaviors among Kenyan young adults living in urban slum settlements: A process evaluation. PLoS One 2020; 15:e0231248. [PMID: 32275677 PMCID: PMC7147752 DOI: 10.1371/journal.pone.0231248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 03/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Respondent-driven sampling (RDS) is a peer-referral sampling methodology used to estimate characteristics of underserved groups that cannot be randomly sampled. RDS has been implemented in several settings to identify hidden populations at risk for HIV, but few studies have reported the methodological lessons learned on RDS design and implementation for assessing sexual risk behaviors in marginalized youth. Methods We used RDS to recruit N = 350 young adults, aged 18 to 22, who were living in urban slum settlements in Nairobi, Kenya. A structured survey was used to assess sexual risk behaviors. Twenty seeds were selected and asked to recruit up to three eligible peers. We used small monetary incentives and a three-day recruitment coupon with sequential numbers linking recruiters to their recruits. Results Data collection was completed in 8 days with a maximum chain length of 6 waves. Each seed yielded 16 to 21 eligible recruits. Three (15%) seeds were unproductive and were replaced. RDS benefits were high identification rates (90% coupons returned per coupons given), high eligibility rates (100% eligible recruits per coupons returned), and high efficiency (~39 eligible recruits per day). 44% of the sample was female. Most recruits (74%) reported being “friends” for 7+ years with their recruiter. RDS overcame feasibility concerns of household-, clinic-, and school-based sampling methodologies in that underserved youth who were unemployed (68%), out of school (48%), ethnic minorities (26%), and having prior residential instability (≥2 moves in the past year) (20%) were successfully recruited, based on weighted analyses. Youth reporting HIV risk behaviors, including unprotected sex (38%), sex while high/drunk (35%), and sex exchange for pay (14%), were also enrolled. However, 28% were not sexually active within the last 6 months. Challenges included managing wait times during peaks and participant referral expectations. Community engagement, use of study-stamped coupons, broad inclusion criteria, incentives, and study sites within walking distances all contributed to the successful implementation of the sampling methodology. Conclusion RDS is an important tool in reaching a diverse sample of underserved and at-risk young adults for study participation. Implications for optimizing RDS for behavioral studies in this population are discussed.
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Affiliation(s)
- Larissa Jennings Mayo-Wilson
- Department of Applied Health Sciences, Indiana University School of Public Health, Bloomington, Indiana, United States of America
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Muthoni Mathai
- Department of Psychiatry, University of Nairobi, College of Health Sciences, Kenyatta National Hospital, Nairobi, Kenya
- Department of Mental Health, National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Nairobi, Kenya
| | - Grace Yi
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Margaret O. Mak’anyengo
- Department of Psychiatry, University of Nairobi, College of Health Sciences, Kenyatta National Hospital, Nairobi, Kenya
- Department of Mental Health, National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Nairobi, Kenya
| | - Melissa Davoust
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Massah L. Massaquoi
- Department of International Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Fred M. Ssewamala
- Washington University in St. Louis, The Brown School, Goldfarb, One Brookings, Drive, St. Louis, Missouri, United States of America
| | - Nancy E. Glass
- Johns Hopkins University School of Nursing, Baltimore, Maryland, United States of America
| | - NAHEDO Study Group
- Department of Mental Health, National Health and Development Organization (NAHEDO), Kenyatta National Hospital, Nairobi, Kenya
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20
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Stannah J, Dale E, Elmes J, Staunton R, Beyrer C, Mitchell KM, Boily MC. HIV testing and engagement with the HIV treatment cascade among men who have sex with men in Africa: a systematic review and meta-analysis. Lancet HIV 2019; 6:e769-e787. [PMID: 31601542 PMCID: PMC6993044 DOI: 10.1016/s2352-3018(19)30239-5] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/27/2019] [Accepted: 07/04/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND HIV disproportionately affects gay, bisexual, and other men who have sex with men (MSM) in Africa, where many countries criminalise same-sex behaviour. We assessed changes in the engagement of African MSM with HIV testing and treatment cascade stages over time, and the effect of anti-LGBT legislation and stigma. METHODS We systematically searched Embase, Global Health, MEDLINE, Scopus, and Web of Science for peer-reviewed cross-sectional or longitudinal studies recruiting at least ten MSM, published from Jan 1, 1980, to Oct 10, 2018. We extracted or derived estimates of HIV testing, engagement with the HIV treatment cascade, or both among African MSM from published reports. We derived pooled estimates using inverse-variance random-effects models. We used subgroup and meta-regression analysis to assess associations between testing and status awareness outcomes and study and participant characteristics, including the severity of country-level anti-LGBT legislation. FINDINGS Our searches identified 75 independent eligible studies that provided estimates for 44 993 MSM across one or more of five testing and treatment cascade outcomes. HIV testing increased significantly over time overall, with pooled proportions of MSM ever tested for HIV of 67·3% (95% CI 62·1-72·3; 44 estimates) and tested in the past 12 months of 50·1% (42·4-57·8, 31 estimates) after 2011, which were 14·8 percentage points and 17·9 percentage points higher than before 2011, respectively. After 2011, ever testing was highest in southern Africa (80·0%), and lowest in northern Africa (34·4%), with the greatest increase in western Africa (from 42·4% to 70·9%). Levels of testing ever, in the past 12 months, and status awareness were statistically significantly lower in countries with the most severe anti-LGBT legislation compared with countries with the least severe legislation (57·4% vs 71·6%, p=0·0056; 35·5% vs 49·3%, p=0·010; 6·7% vs 22·0%, p=0·0050). Few estimates were available for later stages of the treatment cascade. Available data after 2011 suggest that the pooled proportion of MSM HIV-positive aware has remained low (18·5%, 12·5-25·3; 28 estimates), whereas proportions of current antiretroviral therapy (ART) use were 23·7% (15·5-33·0; 13 estimates) among all MSM living with HIV and 60·1% (48·6-71·1; five estimates) among MSM HIV-positive aware of their status. Pooled levels of viral suppression among MSM currently on ART were 75·6% (64·4-85·5; four estimates), but only 24·7% (18·8-31·2; four estimates) among all MSM living with HIV. INTERPRETATION Despite improvements in HIV testing among MSM in Africa, HIV status awareness, ART coverage, and viral suppression remain much lower than required to achieve UNAIDS 90-90-90 targets. Further studies are urgently needed to provide more accurate estimates of levels of status awareness, engagement in care, ART coverage, and viral suppression among MSM to inform prevention efforts aimed at improving access to HIV services for MSM. Severe anti-LGBT legislation might be associated with lower HIV testing and status awareness; therefore, further research is needed to assess the effect of such legislation on HIV testing and engagement with the HIV treatment cascade among MSM. FUNDING US National Institutes of Health, UK Medical Research Council.
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Affiliation(s)
- James Stannah
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Elizabeth Dale
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Jocelyn Elmes
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Roisin Staunton
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA, USA
| | - Kate M Mitchell
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK
| | - Marie-Claude Boily
- Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College London, London, UK; HIV Prevention Trials Network Modelling Centre, Imperial College London, London, UK.
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21
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Hsiao YH, Lee IK, Lin TY, Liao CH, Lee CH, Ku WW, Huang SS, Yu CH, Liu ZH, Chiu YC, Lin YH, Chen NY. Demographic differences in people living with HIV according to recruitment sources: comparison between health-care systems and social media networks. AIDS Care 2019; 32:901-906. [PMID: 31533457 DOI: 10.1080/09540121.2019.1668524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
With the improvement of internet technology in health applications, the utilization of internet and social media as new survey methodologies and recruitment source for research participants have been encouraged, yet evidence of the feasibility in people living with HIV (PLHIV) study is still lacking. We conducted a cross-sectional survey to determine whether there are differences among PLHIV recruited from social media networks and health-care systems using an HIV stigma and discrimination questionnaire. The result revealed that PLHIV recruited from social media networks were younger, more sexually active, and had higher educational status and awareness of the country's HIV rights protection laws than those recruited from hospitals. By contrast, participants recruited from hospitals were more diverse regarding key population compositions, had lived with HIV for a longer duration, had a higher prevalence of concomitant physical disabilities than those recruited from social media networks, and fit Taiwan PLHIV characteristics described by 2016 census from Taiwan Centres for Disease Control. We conclude that sampling bias exists when utilizing social media networks for PLHIV studies.
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Affiliation(s)
- Yu-Hsiang Hsiao
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Persons with HIV/AIDS Rights Advocacy Association of Taiwan, Taipei, Taiwan
| | - Ing-Kit Lee
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Te-Yu Lin
- Department of Internal Medicine, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | | | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital Kaohsiung Branch, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Wei Ku
- Department of Internal Medicine, Taipei Veterans General Hospital, Hsinchu, Taiwan
| | - Shie-Shian Huang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital Keelung Branch, Keelung, Taiwan
| | - Chia-Hui Yu
- Department of medical Quality, Chung Shan Medical University Hospital, Taichung, Taiwan.,College of Nursing, Chung Shan Medical University, Taichung, Taiwan
| | - Zhuo-Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Yi-Chi Chiu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Persons with HIV/AIDS Rights Advocacy Association of Taiwan, Taipei, Taiwan
| | - Yi-Hui Lin
- Persons with HIV/AIDS Rights Advocacy Association of Taiwan, Taipei, Taiwan
| | - Nan-Yu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University College of Medicine, Taoyuan, Taiwan
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22
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Rao A, Ewing W, Ketende S, Wirtz AL, Jumbe V, Trapence G, Kamba D, Umar E, Beyrer C, Muula AS, Baral S. Correlates of Water-Based Lubricant Use Among Men Who Have Sex with Men in Blantyre, Malawi. AIDS Res Hum Retroviruses 2019; 35:833-841. [PMID: 31204861 DOI: 10.1089/aid.2018.0287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Condom compatible lubricants (CCLs), including water-based lubricants (WBL) represent one strategy to prevent the breakage of latex condoms and thus decrease the risk of HIV transmission during anal intercourse. The analyses presented here characterize the correlates of WBL use during anal sex among men who have sex with men (MSM) in Blantyre, Malawi enrolled from April 2011 to March 2012 using respondent-driven sampling (RDS). Bivariate and multivariable logistic regression analyses with RDS-weighting were conducted on a total sample of 338 MSM. With RDS-weighting, 25.4% [95% confidence interval (CI): 20.3-31.4] of MSM (106/329) reported primarily using WBL during anal sex. In multivariable analysis, higher income [adjusted odds ratio (aOR): 5.9; 95% CI: 2.48-14.19], family being aware of their sexual practices (aOR: 2.52; 95% CI: 1.29-4.92), and reporting consistent condom use in the last 6 months (aOR: 1.27; 95% CI: 1.06-1.52) were positively associated with WBL use. Increasing age (per 1 year increase in age; aOR: 0.89; 95% CI: 0.83-0.95) was negatively associated with WBL. Taken together, these data highlight the limited uptake of WBL among MSM in Blantyre, Malawi, especially among older men and those belonging with lower income. Older MSM in Malawi are known to have a higher prevalence of HIV and lower reported use of WBL, suggesting significant risks of onward HIV transmission. Separately, the limited use among those with lower incomes suggests the need for free or subsidized distribution of CCL together with condoms and counseling about their use specifically for MSM in Malawi.
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Affiliation(s)
- Amrita Rao
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Whitney Ewing
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sosthenes Ketende
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea L. Wirtz
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Vincent Jumbe
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
- Centre for Global Health, Trinity College, Dublin, Ireland
| | - Gift Trapence
- Centre for the Development of People, Blantyre, Malawi
| | - Dunker Kamba
- Centre for the Development of People, Blantyre, Malawi
| | - Eric Umar
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Chris Beyrer
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Adamson S. Muula
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Stefan Baral
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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23
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Lyons CE, Coly K, Bowring AL, Liestman B, Diouf D, Wong VJ, Turpin G, Castor D, Dieng P, Olawore O, Geibel S, Ketende S, Ndour C, Thiam S, Touré-Kane C, Baral SD. Use and Acceptability of HIV Self-Testing Among First-Time Testers at Risk for HIV in Senegal. AIDS Behav 2019; 23:130-141. [PMID: 31197701 PMCID: PMC6773816 DOI: 10.1007/s10461-019-02552-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
HIV Self-Testing (HIVST) aims to increase HIV testing coverage and can facilitate reaching the UNAIDS 90-90-90 targets. In Senegal, key populations bear a disproportionate burden of HIV and report limited uptake of HIV testing given pervasive stigma and criminalization. In these contexts, HIVST may represent a complementary approach to reach populations reporting barriers to engagement with existing and routine HIV testing services. In this study, 1839 HIVST kits were distributed in Senegal, with 1149 individuals participating in a pre-test questionnaire and 817 participating in a post-test questionnaire. Overall, 46.9% (536/1144) were first-time testers and 26.2% (300/1144) had tested within the last year; 94.3% (768/814) reported using the HIVST, and 2.9% (19/651) reported a reactive result which was associated with first-time testers (p = 0.024). HIVST represents an approach that reached first-time testers and those who had not tested recently. Implementation indicators suggest the importance of leveraging existing community structures and programs for distribution.
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24
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Kilembe W, Inambao M, Sharkey T, Wall KM, Parker R, Himukumbwa C, Tichacek A, Malama K, Visoiu AM, Price M, Chomba E, Allen S. Single Mothers and Female Sex Workers in Zambia Have Similar Risk Profiles. AIDS Res Hum Retroviruses 2019; 35:814-825. [PMID: 31204869 DOI: 10.1089/aid.2019.0013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of the study was to compare reproductive health and high-risk behaviors in female sex workers (FSWs) and single mothers (SMs) in Zambia's two largest cities, Lusaka and Ndola. FSWs were invited from known community hot spots, and sexually active HIV- SMs were referred from infant vaccination services for free and anonymous screening and treatment for HIV and other sexually transmitted infections (STIs) and long acting reversible contraception. A subset completed an interviewer-administered survey. From 2012 to 2016, 1,893 women (1,377 FSWs and 516 HIV- SMs) responded to referrals. HIV prevalence was 50% in Lusaka and 33% in Ndola FSWs. Positive syphilis serology (rapid plasmin reagin) was found in 29%-31% of HIV+ FSWs and 9%-12% of HIV- FSWs and SMs. Trichomonas was more common in Ndola (11%-12%), compared with Lusaka (3%-7%). Antiretroviral therapy (ART) use among HIV+ FSWs was 9%-15%. In all groups, consistent condom use (8%-11%) and modern contraceptive use (35%-65%) were low. Low literacy and reported coercion at first sexual intercourse were common in both FSWs and SMs, as was alcohol use during sex among FSWs. Zambian FSWs and SMs have low condom use and high HIV/STI and unplanned pregnancy risk. Many FSWs and half of SMs are ≥25 years of age, and thus too old for HIV prevention services targeting "adolescent girls and young women" (aged 15-24). Tailored and targeted reproductive health services are needed to reduce HIV, STI, and unplanned pregnancy in these vulnerable women.
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Affiliation(s)
| | | | | | - Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | | | - Matt Price
- International AIDS Vaccine Initiative (IAVI), New York, New York
| | - Elwyn Chomba
- Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, Georgia
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25
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Leveraging Geospatial Approaches to Characterize the HIV Prevention and Treatment Needs of Out-of-School Adolescent Girls and Young Women in Ethiopia. AIDS Behav 2019; 23:183-193. [PMID: 31134462 PMCID: PMC6773675 DOI: 10.1007/s10461-019-02537-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Adolescent girls and young women (AGYW) remain underserved and at risk for HIV acquisition in Ethiopia. However, there is significant risk heterogeneity among AGYW with limited consensus on optimal strategies of identifying vulnerable AGYW. This study assessed the utility of venue-based sampling approaches to identify AGYW at increased risk for HIV infection. Venue mapping and time-location-sampling (TLS) methods were used to recruit AGYW from three sub-cities of Addis Ababa, February–June 2018. Interviewer-administered surveys captured socio-demographic and behavioral characteristics. Measures of AGYW vulnerability were assessed geographically and described by venue type. A total of 2468 unique venues were identified, of which 802 (32%) were systematically selected for validation and 371 (46%) were eligible including many sites that would traditionally not be included as venues in need of HIV prevention services. Overall, 800 AGYW were enrolled across 81 sampled venues. AGYW reached were largely out-of-school (n = 599, 75%) with high proportions of AGYW reporting transactional sex (n = 101, 12.6%), food insecurity (n = 165, 20.7%) and migration (n = 565, 70.6%). Taken together, these data suggest the utility of TLS methods in reaching vulnerable, out-of-school AGYW in Addis Ababa, Ethiopia.
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26
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Ingabire R, Parker R, Nyombayire J, Ko JE, Mukamuyango J, Bizimana J, Price MA, Laufer D, Tichacek A, Wall K, Allen S, Karita E. Female sex workers in Kigali, Rwanda: a key population at risk of HIV, sexually transmitted infections, and unplanned pregnancy. Int J STD AIDS 2019; 30:557-568. [PMID: 30727831 PMCID: PMC6512058 DOI: 10.1177/0956462418817050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 11/12/2018] [Indexed: 12/17/2022]
Abstract
Female sex workers (FSWs) were recruited from known hotspots in Kigali, Rwanda, and offered free, anonymous human immunodeficiency virus (HIV) counseling and testing, diagnosis and treatment of sexually transmitted infections (STIs) and long-acting reversible contraception (LARC). From September 2012 to March 2015, 1168 FSWs sought services, including 587 (50%) who were HIV-positive. More than 90% had previously tested for HIV, and 26% who reported previously testing negative had seroconverted. Of the 349 who already knew their HIV-positive status, 74% were on antiretroviral treatment. The prevalence of serologic syphilis was 43% in HIV-positive and 19% in HIV-negative FSWs (p < 0.0001), and Trichomonas vaginalis was found in vaginal wet mounts in 21% of HIV-positive and 13% of HIV-negative FSWs (p < 0.0001). Signs and symptoms of STIs were found in 35% of HIV-positive compared with 21% of HIV-negative FSWs (p < 0.0001). Only one-third reported consistent condom use in the last month. Modern contraceptive use was reported by 43% of HIV-positive and 56% of HIV-negative FSWs (p < 0.0001). Current pregnancy was reported by 4% of HIV-positive and 6% of HIV-negative FSWs (p = 0.0409). Despite Rwanda's successes with preventing 70% of new infections in the general population through nationwide couples' testing in antenatal clinics, prevention and timely treatment in key populations including FSWs are lacking. The prevalence of HIV - including many new cases - and STIs among FSWs in Kigali is high and condom and contraceptive use are low. Tailored and integrated HIV/STIs and family planning programs are urgently needed for FSWs.
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Affiliation(s)
- Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | - Julien Nyombayire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
| | - Jasmine E Ko
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | | | - Jean Bizimana
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
| | - Matt A Price
- International AIDS Vaccine Initiative, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of
California at San Francisco, San Francisco, CA, USA
| | - Dagna Laufer
- International AIDS Vaccine Initiative, New York, NY, USA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | - Kristin Wall
- Department of Epidemiology, Rollins School of Public Health,
Emory University, Atlanta, GA, USA
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology &
Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA,
USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Kigali,
Rwanda
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Hearld KR, Milner AN, Budhwani H, Abreau N, Rodriguez-Lauzurique RM, Charow R, Paulino-Ramirez R. Alcohol Use, High Risk Behaviors, and Experiences of Discrimination Among Transgender Women in the Dominican Republic. Subst Use Misuse 2019; 54:1725-1733. [PMID: 31046549 DOI: 10.1080/10826084.2019.1608253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: This study examines associations between alcohol use, high risk sexual behaviors, and experiences of stigma among transgender women across the Dominican Republic. Data from the 2015 Transgender Health Needs Study were analyzed using bivariate analyses (N = 291). Results: High rates of stigma, verbal abuse, alcohol use, and sex work are found and are associated with each other. Almost 45% of regular alcohol users are engaging in sex work (43.6%), compared with 31.1% of the non-regular alcohol users (χ2=4.82, p < .05). Having sex under the influence of alcohol is statistically associated with high risk behaviors, such as engaging in sex work, sometimes or never using a condom when receiving anal sex, and higher numbers of sexual partners. Furthermore, transgender women who have had sex under the influence of alcohol report statistically significantly higher levels of verbal abuse, discrimination, and levels of perceived transgender stigma. Conclusions/Importance: Findings suggest that although anti-discrimination laws exist, policies may not protect transgender women from experiencing stigma and discrimination at work, potentially forcing them to seek alternative careers and engage in behaviors that expose them to greater personal risk and harm. This intersection of factors may indicate a notable public health gap in transgender health in the Dominican Republic.
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Affiliation(s)
| | | | - Henna Budhwani
- a University of Alabama at Birmingham , Birmingham , Alabama , USA
| | - Nicole Abreau
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana
| | - Rosa Mayra Rodriguez-Lauzurique
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana.,d Centro de Orientacion e Investigacion Integral (COIN) , Santo Domingo , República Dominicana
| | - Rebecca Charow
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana
| | - Robert Paulino-Ramirez
- c Instituto de Medicina Tropical and Salud Global , Universidad Iberoamericana-UNIBE , Los Rios , Santo Domingo , República Dominicana.,d Centro de Orientacion e Investigacion Integral (COIN) , Santo Domingo , República Dominicana
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Grasso MA, Manyuchi AE, Sibanyoni M, Marr A, Osmand T, Isdahl Z, Struthers H, McIntyre JA, Venter F, Rees HV, Lane T. Estimating the Population Size of Female Sex Workers in Three South African Cities: Results and Recommendations From the 2013-2014 South Africa Health Monitoring Survey and Stakeholder Consensus. JMIR Public Health Surveill 2018; 4:e10188. [PMID: 30087089 PMCID: PMC6104000 DOI: 10.2196/10188] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/21/2018] [Accepted: 06/11/2018] [Indexed: 11/20/2022] Open
Abstract
Background Robust population size estimates of female sex workers and other key populations in South Africa face multiple methodological limitations, including inconsistencies in surveillance and programmatic indicators. This has, consequently, challenged the appropriate allocation of resources and benchmark-setting necessary to an effective HIV response. A 2013-2014 integrated biological and behavioral surveillance (IBBS) survey from South Africa showed alarmingly high HIV prevalence among female sex workers in South Africa’s three largest cities of Johannesburg (71.8%), Cape Town (39.7%), and eThekwini (53.5%). The survey also included several multiplier-based population size estimation methods. Objective The objective of our study was to present the selected population size estimation methods used in an IBBS survey and the subsequent participatory process used to estimate the number of female sex workers in three South African cities. Methods In 2013-2014, we used respondent-driven sampling to recruit independent samples of female sex workers for IBBS surveys in Johannesburg, Cape Town, and eThekwini. We embedded multiple multiplier-based population size estimation methods into the survey, from which investigators calculated weighted estimates and ranges of population size estimates for each city’s female sex worker population. Following data analysis, investigators consulted civil society stakeholders to present survey results and size estimates and facilitated stakeholder vetting of individual estimates to arrive at consensus point estimates with upper and lower plausibility bounds. Results In total, 764, 650, and 766 female sex workers participated in the survey in Johannesburg, Cape Town, and eThekwini, respectively. For size estimation, investigators calculated preliminary point estimates as the median of the multiple estimation methods embedded in the IBBS survey and presented these to a civil society-convened stakeholder group. Stakeholders vetted all estimates in light of other data points, including programmatic experience, ensuring inclusion only of plausible point estimates in median calculation. After vetting, stakeholders adopted three consensus point estimates with plausible ranges: Johannesburg 7697 (5000-10,895); Cape Town 6500 (4579-9000); eThekwini 9323 (4000-10,000). Conclusions Using several population size estimates methods embedded in an IBBS survey and a participatory stakeholder consensus process, the South Africa Health Monitoring Survey produced female sex worker size estimates representing approximately 0.48%, 0.49%, and 0.77% of the adult female population in Johannesburg, Cape Town, and eThekwini, respectively. In data-sparse environments, stakeholder engagement and consensus is critical to vetting of multiple empirically based size estimates procedures to ensure adoption and utilization of data-informed size estimates for coordinated national and subnational benchmarking. It also has the potential to increase coherence in national and key population-specific HIV responses and to decrease the likelihood of duplicative and wasteful resource allocation. We recommend building cooperative and productive academic-civil society partnerships around estimates and other strategic information dissemination and sharing to facilitate the incorporation of additional data as it becomes available, as these additional data points may minimize the impact of the known and unknown biases inherent in any single, investigator-calculated method.
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Affiliation(s)
- Michael A Grasso
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | | | | | - Alex Marr
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Tom Osmand
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Zachary Isdahl
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Helen Struthers
- Anova Health Institute, Johannesburg, South Africa.,Division of Infectious Diseases & HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - James A McIntyre
- Anova Health Institute, Johannesburg, South Africa.,School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Francois Venter
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Helen V Rees
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
| | - Tim Lane
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States
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29
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Age bias in survey sampling and implications for estimating HIV prevalence in men who have sex with men: insights from mathematical modelling. Epidemiol Infect 2018; 146:1036-1042. [PMID: 29708084 DOI: 10.1017/s0950268818000961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Respondent-driven sampling (RDS) is widely used to estimate HIV prevalence in men who have sex with men (MSM). Mathematical models that are calibrated to these data may be compromised if they fail to account for selection biases in RDS surveys. To quantify the potential extent of this bias, an agent-based model of HIV in South Africa was calibrated to HIV prevalence and sexual behaviour data from South African studies of MSM, first reweighting the modelled MSM population to match the younger age profile of the RDS surveys (age-adjusted analysis) and then without reweighting (unadjusted analysis). The model estimated a median HIV prevalence in South African MSM in 2015 of 34.6% (inter-quartile range (IQR): 31.4-37.2%) in the age-adjusted analysis, compared with 26.1% (IQR: 24.1-28.4%) in the unadjusted analysis. The median lifetime risk of acquiring HIV in exclusively homosexual men was 88% (IQR: 82-92%) in the age-adjusted analysis, compared with 76% (IQR: 64-85%) in the unadjusted analysis. These results suggest that RDS studies may under-estimate the exceptionally high HIV prevalence rates in South African MSM because of over-sampling of younger MSM. Mathematical models that are calibrated to these data need to control for likely over-sampling of younger MSM.
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30
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Rice B, Boulle A, Baral S, Egger M, Mee P, Fearon E, Reniers G, Todd J, Schwarcz S, Weir S, Rutherford G, Hargreaves J. Strengthening Routine Data Systems to Track the HIV Epidemic and Guide the Response in Sub-Saharan Africa. JMIR Public Health Surveill 2018; 4:e36. [PMID: 29615387 PMCID: PMC5904448 DOI: 10.2196/publichealth.9344] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/08/2018] [Accepted: 02/14/2018] [Indexed: 01/09/2023] Open
Abstract
The global HIV response has entered a new phase with the recommendation of treating all persons living with HIV with antiretroviral therapy, and with the goals of reducing new infections and AIDS-related deaths to fewer than 500,000 by 2020. This new phase has intensive data requirements that will need to utilize routine data collected through service delivery platforms to monitor progress toward these goals. With a focus on sub-Saharan African, we present the following priorities to improve the demand, supply, and use of routine HIV data: (1) strengthening patient-level HIV data systems that support continuity of clinical care and document sentinel events; (2) leveraging data from HIV testing programs; (3) using targeting data collection in communities and among clients; and (4) building capacity and promoting a culture of HIV data quality assessment and use. When fully leveraged, routine data can efficiently provide timely information at a local level to inform action, as well as provide information at scale with wide geographic coverage to strengthen estimation efforts.
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Affiliation(s)
- Brian Rice
- Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Paul Mee
- Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Elizabeth Fearon
- Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Georges Reniers
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jim Todd
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sandra Schwarcz
- Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - Sharon Weir
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, United States
| | - George Rutherford
- Global Health Sciences, University of California San Francisco, San Francisco, CA, United States
| | - James Hargreaves
- Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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31
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Rice B, Sanchez T, Baral S, Mee P, Sabin K, Garcia-Calleja JM, Hargreaves J. Know Your Epidemic, Strengthen Your Response: Developing a New HIV Surveillance Architecture to Guide HIV Resource Allocation and Target Decisions. JMIR Public Health Surveill 2018; 4:e18. [PMID: 29444766 PMCID: PMC5830609 DOI: 10.2196/publichealth.9386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 11/14/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022] Open
Abstract
To guide HIV prevention and treatment activities up to 2020, we need to generate and make better use of high quality HIV surveillance data. To highlight our surveillance needs, a special collection of papers in JMIR Public Health and Surveillance has been released under the title “Improving Global and National Responses to the HIV Epidemic Through High Quality HIV Surveillance Data.” We provide a summary of these papers and highlight methods for developing a new HIV surveillance architecture.
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Affiliation(s)
- Brian Rice
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Stefan Baral
- Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Paul Mee
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Keith Sabin
- Strategic Information and Evaluation, Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | | | - James Hargreaves
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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